Paediatric orthopaedics Flashcards
CTEV
- presentation
- management
Congenital talipes equino varus usually detected at birth males > females deformity: ankle and foot may be bilateral hind foot equinus forefoot adduction / supination
- obtain straight position, painless, plantigrade and mobile foot.
- mob: corrects position
- serial casting / splinting / strapping - to maintain corrected positions
eg. ponseti - good outcome
followed by Denis Browne splint
surgical corrections if conservative rx fails
Role of physio - role in correction of position during serial casting Restore ROM post surgery / casting restore strength post surgery gait education/ normal development
ddh
features
3 types
developmental dysplasia of hip
abnormal developments of one or more of components of the hip joint
associated with a shallow acetabulum with an altered angle of femoral head
3 types
dislocation
subluxation
dislocatable
signs ddh
unilateral \+ Barlow / Otolani tests decreased abduction in one hip asymmetrical skin crease shortness of one leg trendelenberg gait antalgic gait
Bilateral wide perineum wide pelvis increased lumbar lordosis waddling gait trendelenburg symmetrrical limited abduction
management ddh
maintain hip abduction to encourage hip capsule to tighten
90% of unstable hips stabilise by week 9
maximum remodelling of acetabulum occurs below 18 months
conservative - MUA
splints: pavlik up to 6 months / plaster hip spica
surgical management - if conservative mgmt fails
role of physio
detection?
during splint stage - advise parents on splint care / skin care
advice on lifting / handling
promote normal development
infant important to achieve important milestones
Postop - ROM muscle strengthening hydrotherapy gait training
Perthes’ disease
osteochondritis of head of femur irritable hip children 4-10 years M>F uni / bi self limiting up to 3 years but may have residual deformity long term - risk of OA
Perthes - clinical
- x-ray
clinical pain limp dec. ROM- abduction / MR collapse of head of femur limb shortening
X-ray - epiphyseal density widening of joint space fragmentation of femoral head short femoral neck
Perthes’ treatment
non-surgical observation only anti-inflammatory protected weight bearing bed rest in traction cast / splinting
surgical - femoral and /pelvic osteotomy
Role of physio
detection = child with pain limp and limited movement
during splint stage - advice skin care / splint care
promote normal development, gait training
post op ROM Muscle strengthening, hydrotherapy, gait training
osteochondritis
femoral head - perches head - 2nd/ 3rd MT - freiberg's disease vertebral bodies - scheuermanns disease navicular - Kohler's disease lunate - kienboks disease
SCFE
features
slipped capital femoral epiphysis adolescent males: females 5:1 clinically overweight 20% of cases bilateral causes = trauma, hormonal, familia link
presentation SCFE
diagnosis
complications
treatment
two types
acute - post trauma - fall
severe pain + unable to wB
Chronic limp loss of ROM/ MR Aching pain limb shorter confirmed by -xray sep of bone-cartilage interface in upper femoral epiphysis head of femur in acetabulum NOF ER + Slides up diagnosis history of limp +/- fall or trip occasional groin or knee pain confirmed by x-ray
complications AVN Early OA stiff hip other hip involvement
in situ pinning
SCFE physio
post op ROM assisted active exercise hydrotherapy NWB gait initially progress to PWB walking aids gait education
Other education exercise ROM role in weight reduction functional activities observe opposite hip
Idiopathic scoliosis
lateral curvature of the spine females > males infantile scoliosis by age 3 juvenile age 4-10 adolescent age 10 until skeletal maturity slight curvature - severe deformity
clinical features
spinal curvature
shoulders not level
pelvis not level
waist not level
management
conservative - curves <40 degrees physio bracing curves for 25-40 degrees bracing worn up to 20 hours a day prevent curve from progressing operate on the principle of 3 point pressure on the spine surgery curves > 40 degrees Harrington rods
bracing
Milwaukee brace
Boston brace
role of physio - scoliosis
for mild curves
scoliosis exercises - schroth therapy
stretching strengthening and breathing exercises of all directions of all existing abnormal curvatures
stand alone or with bracing or post op
can prevent 2 problems - lack of mobility reduced spinal strength resp problems
assoc resp problems - breathing exercises, cv exercise
other exercise, core stability, pilates, yoga
traction apophysitis
overuse injury at attachment of muscle to bone assoc with sports may be assoc with growth spurt affects adolescents common sites = base of 5th MT insertions of peroneal muscles tibial tuberosity calcaneal epipihysis
management
activity modification relative rest use of ice for swelling / pain address limitations in strength / flex predisposing factors consider
