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MSK (Medicine 2: Year 2) > Paediatric Orthopaedics - Complex Needs > Flashcards

Paediatric Orthopaedics - Complex Needs Flashcards

1
Q

What is a child with complex needs defined as?

A

multiple and complex disabilities and has at least two different types of severe or profound impairment

complex exceptional needs include:

  • learning and mental function
  • communication
  • motor skills
  • self care
  • hearing
  • vision
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2
Q

What does CP stand for?

A

Cerebral palsy

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3
Q

What is cerebral palsy?

A

permanent and non-progressive motor disorder due to brain damage before birth or during first 2 years of life

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4
Q

What is the incidence of CP?

A
  • 2/1000 births
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5
Q

What is the aetiology of CP?

A
  • Prenatal
    • Placental insufficiency
    • Toxaemia
    • Smoking
    • Alcohol
    • Drugs
  • Perinatal
    • Prematurity (most common)
    • Anoxic injuries
    • Infections
  • Postnatal
    • Infection (CMV, rubella)
    • Head trauma
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6
Q

What infections can cause CP?

A

CMV, rubella

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7
Q

What are the different classifications of CP?

A
  • physiological
  • anatomical
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8
Q

What are the different physiological classifications of CP?

A
  • spastic (pyramidal system, motor cortex)
  • athetoid (extrapyramidal system, basal ganglia)
  • ataxia (cerebellum and brainstem)
  • mixed (combination of spasticity and athetosis)
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9
Q

What are the different anatomical classifications of CP?

A
  • Monoplegia (one limb involved)
  • Hemiplegia (one side of body)
  • Diplopia (lower limbs)
  • Quadriplegia (total body involvement)
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10
Q

What is affected in spastic CP?

A
  • Spastic (pyramidal system, motor cortex)
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11
Q

What is affected in athetoid CP?

A
  • Athetoid (extrapyramidal system, basal ganglia)
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12
Q

What is affected in ataxia CP?

A
  • Ataxia (cerebellum and brainstem)
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13
Q

What is mixed CP?

A
  • Mixed (combination of spasticity and athetosis)
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14
Q

What physiological classification of CP is most common?

A
  • Spastic (pyramidal system, motor cortex)
    • Most common
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15
Q

What is CP that affects one limb called?

A
  • Monoplegia (one limb involved)
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16
Q

What is CP that affects one side of the body called?

A
  • Hemiplegia (one side of body)
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17
Q

What is CP that affects the lower limbs called?

A

Diplegia (lower limbs)

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18
Q

What is CP that affects total body movement called?

A
  • Quadriplegia (total body involvement)
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19
Q

What is GMFCS?

A

GMFCS (gross motor function classification system)

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20
Q

What is used to clinically classify CP?

A

GMFCS (gross motor function classification system)

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21
Q

What are the 5 levels of GMFCS for CP?

A
  • Level 1
    • Walks without limitations
  • Level 2
    • Walks with limitations
  • Level 3
    • Walks using hand held mobility device
  • Level 4
    • Self-mobility with limitations
  • Level 5
    • Transported in manual wheelchair
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22
Q

What are clinical features of CP?

A
  • Spasticity
  • Lack of voluntary limb control
  • Weakness
  • Poor co-ordination
  • Impaired senses
23
Q

Describe the progression of CP?

A

dynamic contractures

  • increased muscle tone and hyper-reflexes
  • no fixed deformity of joints
  • deformity can be overcome

Progress to fixed muscle contractures

  • persistent spasticity and contracture
  • shortened muscle tendon units
  • deformity cannot be overcome

Can progress to joint subluxation/dislocation

  • secondary bone changes/joint degeneration
24
Q

What are the orthopaedic priorities for management of CP?

A
  • maintain sitting balance
  • maintain standing posture
  • optimise gait if they can walk
25
Q

How can gait be analysed?

A
  • Observation
  • Video
  • 3D instrumented analysis
  • EMG
26
Q

What is gait?

A

A persons manner of walking

27
Q

What are the different phases of gait?

A
  • Stance phase
  • Swing phase
28
Q

Describe the gait cycle?

A
29
Q

What is a major complication of CP?

A

hip displacement and maybe dislocation

30
Q

What intervention can be done for children with CP at risk of dislocation?

A

non-surgical

  • posture management: physiotherapy, seating
  • spasticity management
  • deformity management

surgery

31
Q

What medication can be used for spasticity management in CP?

A

generalised

  • baclofen oral
  • diazepam

localised

  • botulinum toxin
  • baclofen intra-thecal pump
32
Q

What can be done for deformity management in CP?

A
  • soft tissue release
  • bony realignment: varus derotation osteotomy, pelvic osteotomy
33
Q

What is the most common congenital deformity?

A

Congenital talipes equinovarus

34
Q

What is congenital talipes equinovarus also known as?

A

Club foot

35
Q

What is the aetiology of congenital talipes equinovarus?

A
  • genetic
  • multifactorial: in most cases cannot specify why has occurred
36
Q

Describe the epidemiology of congenital talipes equinovarus in terms of incidence and sex?

A
  • 2/1000 births
  • M:F 3:1
37
Q

How is congenital talipes equinovarus often diagnosed?

A
  • Often prior to birth with prenatal US
38
Q

What are the 4 deformities that cause congenital talipes equinovarus?

A
  • Cavus
  • Adductus (midfoot)
  • Varus (hind foot)
  • Equinus (hindfoot)
39
Q

What is the treatment of congenital talipes equinovarus?

A
  • Done in series of casts, from 1 to 5 in weekly intervals
  • Equinus can be corrected by percutaneous tenotomy of Achilles tendon
40
Q

Describe the normal curvature of the spine?

A

Spine normal curvature in sagittal plane:

  • Cervical lordosis
  • Thoracic kyphosis
  • Lumbar lordosis
  • Sacral kyphosis
41
Q

What is scoliosis?

A

Scoliosis = any deviation in coronal plain

42
Q

When does scoliosis have clinical significance?

A

when deviation is >10o

43
Q

What are the 2 kinds of scoliosis?

A
  • non-structural: due to an extrinsic cause
  • structural: intrinsic spinal problem
44
Q

What is the aetiology of non-structural scoliosis?

A

due to extrinsic cause

  • leg length discrepancy
  • hip problem
45
Q

What is the treatment of non-structural scoliosis?

A
  • Resolves when causal factor is addressed
46
Q

What is the aetiology of structural scoliosis?

A
  • Abnormal rotation of vertebrae and is an intrinsic spinal problem
47
Q

What is the risk of progression of structural scoliosis proportional to?

A
  • curve magnitude (Cobb angle)
  • age at presentation
48
Q

What are the 3 major classes of structural scoliosis?

A
  • congenital: abnormalities of formation vertebrae
  • idiopathic
  • neuromuscular
  • others: post-traumatic, degenerative, infection…
49
Q

What position is best to examine structural scoliosis?

A

bent forwards into flexion

50
Q

What investigations are done for scoliosis?

A
  • AP erect whole spine x-ray with or without lateral
  • MRI
    • Cord abnormalities
    • Vertebral abnormalities
    • Tumours
51
Q

Describe the prognosis of scoliosis?

A
  • Outcomes less favourable with severe curves
  • Early diagnosis matters
  • Neuromuscular causes are at high risk of progression
52
Q

What is the mangement of scoliosis?

A

non-surgical: bracing (halts or minimises progression of curve)

surgery: complex and extensive

53
Q

What are some possible complications of surgery for scoliosis?

A
  • backache
  • nerve root damage
  • vascular or cord traction injury
  • degenerative changes later
  • problems of growth

MSK (Medicine 2: Year 2) (45 decks)

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