Paediatrics Flashcards
What is genu valgam?
Knock knees
Do insoles help in genu valgam?
No
genu valgam is knock knees
Which gender does anterior knee pain affect more?
Females
Where is the tenderness in anterior knee pain?
Patellar
Worse with stairs/squats
What investigation would you use for anterior knee pain?
X-ray
The pain may often be because of hip
Where is maximal tenderness at knee in anterior knee pain?
Superior pole patella Inferior pole patella Tibial tuberosity Retropatella Joint Line
Although curly toes generally resolve, which surgical procedure could you perform?
Tenotomy
-No splints
Which toes are commonly affected in curly toes?
3rd/4th toes
What age do children begin to run? And climb stairs using 2 feet?
2 years
By what age have children established an adult gait pattern?
8 years
Congenital orthopaedic conditions?
Club foot (CTEV)
Skeletal dysplasias
CVT (congenital vertical talus)
NF
What is CVT?
Congenital vertical talus
Neuromuscular orthopaedic conditions
CP (non walking) CP (walking) Tip toe walking DMD Cavus foot
What is postural talipes?
Positional talipes is a common condition caused by some tightness in the muscles around the ankle and the position the baby was in whilst in the womb. It is not caused by problems with the bones in their foot and will not cause any problems with walking
CTEV
Congenital talipes equinovarus (club foot)
Congenital talipes equinovarus is a common congenital orthopaedic condition. It is characterised by an excessively turned in foot (equinovarus) and high medial longitudinal arch (cavus)
National Institute for Health NF1
6 or more cafe au lait spots (pigmented birth marks) >5mm pre puberty >15 post puberty 2 or more Neurofibromas or 1 PFN Axillary/groin freckling 2 or more Lisch nodules Pseudarthrosis or thinning Kyphoscoliosis or sphenoid dysplasia 1st degree relative Known genetic mutation 17q11.2
What is neurofibromatosis?
Neurofibromatoses are genetic disorders that cause tumours to grow in the nervous system.
These produce abnormalities like skin changes and bone disorders
Pseudoarthrosis
A bone fracture that has no chance of mending without medical intervention
Known genetic mutation in NF1
17q11.2
Stature in skeletal dysplasia in relation to SD
Short stature <2SD
Gene involved in skeletal dysplasia?
FGFR3
Fibroblast growth factor receptor 3
Genu varum
Bow legs
Trident hand
Hand short with stubby fingers
Achondroplasia method of inheritance
Autosomal dominant
Tumour-like conditions
Diaphyseal Aclasia/MHE
Ollier’s Disease
Fibrous Dysplasia
Trevor’s Disease
Diaphyseal Achalasia / MHE
Multiple osteochondromas throughout the spine
Ollier’s Disease
Multiple enchondromas
Cerebral Palsy
A persisting qualitative motor disorder appearing before the age of three years, due to non progressive damage to the encephalon occurring before the growth of the central nervous system is complete
Where does botox work?
Where the motor neuron enters the muscle
Where do benzodiazepines and baclofen work?
At the synapse
Why could you use a selective dorsal rhizotomy in cerebral palsy?
A rhizotomy (/raɪˈzɒtɵmi/ ry-zot-ə-mee) refers to a neurosurgical procedure that selectively destroys problematic nerve roots in the spinal cord, most often to relieve the symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy
Positive Features of UMN syndrome
Spasticity Hyperreflexia Clonus Co-contraction (neural)
Negative features of UMN syndrome
Weakness Fatiguability Poor balance Sensory deficit (mechanical)
The child at risk in cerebral palsy
higherGMFCS
The higher the risk of dislocation
Prevention programme to prevent hip dislocation in children with cerebral palsy!
Treatment for walking cerebral palsy
GMFCS 1-III Botox A Orthotics Physio Surgery
Tiptoe walking
Usually idiopathic Common before 3 years Physio/observation Splinting/casting Botox Surgery
DMD
X linked recessive Boys (1 in 3,600) Present 2-5 years Dystrophin gene Progressive Gower’s / CPK
Cavus feet
High arch
