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MSK > Paeds Orthopaedics > Flashcards

Paeds Orthopaedics Flashcards

1
Q

Osteogenesis imperfecta

A

Brittle bone disease - autosomal dominant
Defect of maturation of type 1 collagen
Multiple fragility fractures, short stature, blue sclera, loss of hearing

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2
Q

X-ray appearance of ostegenesis imperfecta

A

Thin cortices, osteopenia
Fractures heal with abundant poor quality callus
Deformity

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3
Q

Treatment of osteogenesis imperfecta

A

Rule out NAI
Splits, traction, stabilise
Osteotomy

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4
Q

Skeletal dysplasia

A

Short stature - genetic error

Proportionate or disproportionate

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5
Q

Achondroplasia

A

Commonest form of skeletal dysplasia
Autosomal dominant or sporadic
Short limbs, prominent forehead, wide nose
Lax joints

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6
Q

Treatment of achondroplasia

A

Genetic testing
Deformity correction
Limb lengthening
GH

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7
Q

Generalised familial joint laxity

A

Hypermobility, autosomal dominant
Double jointed
Prone to dislocations

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8
Q

Marfan’s syndrome

A

Autosomal dominant/sporadic mutation of fibrillin gene
Tall stature, long limbs, laxity, high arched palate, scoliosis, pectus excavatum, lens disolcation, retinal detachment, AAA, valve incompetence, pneumothorax

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9
Q

Ehlers-Danlos syndrome

A

Autosomal dominant mutation in elastin/collagen

Hypermobility, vascular fragility, scoliosis, stretchy skin

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10
Q

Down syndrome

A

Trisomy 21
Short stature
Joint laxity, recurrent dislocations, C1/2 instability

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11
Q

DMD

A 
X-linked recessive
Progressive muscle weakness and wasting
Mutation in dystrophin gene (Ca transport)
Gower's sign
Age 20 - cardiac and resp failure
Raised CK
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12
Q

Treatment of DMD

A

Physio, splint, deformity correction

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13
Q

BMD

A

X-linked recessive progressive muscle weakness and wasting

Milder - can walk into teens, death 30s/40s

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14
Q

UMN symptoms (CNS)

A

Weakness, spasticity, hyperreflexia, extensor plantar response

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15
Q

LMN symptoms (anterior horn cells, peripheral nerves)

A

Weakness, reduced tone, hyporeflexia

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16
Q

CP

A

Neuromuscular disorder, onset 2-3 years
Insult to immature brain
Missed milestones, learning difficulties
Monoplegic/hemiplegic/diplegic

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17
Q

Spastic CP

A

Commonest form of CP

UMN symptoms = spasticity, weakness

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18
Q

Ataxic CP

A

Affects cerebellum = balance, coordination

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19
Q

Athetoid CP

A

Writhing, problems with speech

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20
Q

MSK problems in CP

A

Contractures, scoliosis, hip dislocation

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21
Q

Treatment of CP

A

Physio, splints
Baclofen, botox
Surgery

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22
Q

Spinda bifida

A

2 halves of posterior arch fail to fuse in first 6 weeks

Deformity, contractures, hip dislocation

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23
Q

Spina bifida occulta

A

tethering of spinal cord = pes cavus and toe clawing

Dimple or tuft of hair

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24
Q

Spina bifida cystica

A

Contents herniate (meningocele - meninges, myelomeningocele - SC = neuro deficit)
Hydrocephalus
Closed within 48 hours

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25
Treatment of spina bifida
Closure Scoliosis correction Foot deformity correciton Good foot care
26
Polio
Viral infection of anterior horn motor cells = LMN deficit Virus enters GIT = flu like illness = paralysis of 1 limb within days Paralysis, deformities, limb shortening
27
Treatment of polio
Splint, shoe raise Tendon transfer Arthrodesis
28
Syndactyly
2 digits fused | Separation
29
Polydactyly
Extra digit | Amputation
30
Fibular hemimelia
Absence of fibula = shortened limb, bowing of tibia, ankle deformity Prosthetic, amputation
31
Tarsal coalition
Painful flat feet
32
Erb's palsy
Injury to C5/6 Loss of innervation to supraspinatus/deltoid/infraspinatus/biceps/brahicalis IR of humerus = waiter's tip posture
33
Treatment of Erb's palsy
Physio to prevent contracture Surgical release Tendon transfer
34
Klumpke's palsy
``` C8/T1 palsy due to forceful adduction Paralysis of intrinsic hand muscles Horner's syndrome Wrist extended, fingers flexed No specific treatment ```
35
Knee alignment progression
Varus at birth Aligned 14 months 10-15 valgus age 3 6 valgus age 7-9
36
Genu varum
Growth disorder of medial tibial physis (Blount's disease) Increased risk of OA Osteotomy
37
Genu valgum
Rickets, tumours, trauma, NF | Osteotomy
38
Intoeing
Feet point towrads midline | Exaggerated when running, clumsy
39
Causes of in toeing
Femoral neck anteversion Internal tibial torsion Forefoot adduction
40
Mobile flat foot
Arch forms with dorsiflexion of great toe (Jack's test) Ligamentous laxity Flat foot on weight bearing TP dysfunction
41
Rigid flat foot
``` Bony abnormality (tarsal coalition) Pain ```
42
DDH
Dislocation of femoral head during perinatal period = ball and socket joint doesn't form properly
43
DDH is more common in:
``` Girls Left hip FH 1st born Breech Down's syndrome ```
44
Symptoms and signs of DDH
Shallow acetabulum = false acetabulum Shortened limb Severe arthritis Click clunk on Ortolani or Barlow
45
Ortolani
Reducing dislocated hip with abduction and anterior displacement
46
Barlow
Dislocatable hip with flexion and posterior displacement
47
Investigation of DDH
US before 6 months | xray after
48
Treatment of DDH
Pavlik harness 4-6 months | OR
49
Transient hip synovitis
Self limiting inflammation of synovium after URTI | Commonest cause of hip pain in childhood
50
Who gets transient hip synovitis?
Boys 2-10
51
Symptoms and signs of transient hip synovitis
Limp, reluctance to weight bear, restricted ROM | fever
52
Investigation and treatment of transient synovitis of hip
Radiograph to exclude Perthes Normal CRP Aspiration and drainage Tx: NSAIDs and rest
53
Perthes disease
Transient AVN of femoral head | Active, short, pre-pubertal boys
54
Symptoms of Perthes
Pain, limp, loss of IR and abduction | Positive Trendelenburg
55
Treatment for Perthes
Regular xray | Avoid activity
56
SUFE
Overweight pre-pubertal adolescent boys | Femoral head slips inferiorly due to weak growth plate
57
Symptoms of SUFE
Delayed puberty Groin or knee pain, limp Loss of IR
58
Investigations and treatment of SUFE
Need lateral view xray to detect minor slips Urgent surgery to pin femoral head THR
59
Patellar tendonitis
Jumpers knee | Rest and physio
60
Apophysitis
Inflammation of growing tubercle Either end of patellar tendon due to repetitive strain Self limiting - rest and physio
61
Osgood-Schlatter's disease
Inflammation of tibial tubercle
62
Sindig-Larsen-Johnson
Inflammatin of inferior pole of patella
63
Anterior knee pain
Patellofemoral dysfunction Girls, adolescence Due to muscle imbalance/laxity/valgum Rest, physio, surgery
64
Patellar dislocation
Medially Rupture of medial patellofemoral ligament Multiple discloations Physio, surgery
65
Osteochondritis dissecans
Osteochondritis where a fragment of hyaline cartilage and maybe bone breaks off Medial femoral condyle most common Pain, effusion, locking, pothole
66
Talipes equinovarus
Clubfoot In utero abnormal alignment between talus/calcaneous/navicular Contractures = plantarflexion, supination, varus forefoot
67
Who gets clubfoot?
Boys | Breech
68
Treatment of clubfoot
Early splintage (Ponseti) Tenotomy Brace
69
Tarsal coalition
Abnormal bridge between talus/calcaneous or calcaneous/navicular Painful fixed flat foot deformity Splint/orthotics, surgery
70
Hallux valgus
``` FH Bunion (medial angulation of 1st MT, lateral angulation of 1st toe) ```
71
Spondylolisthesis
Slippage of one vertebra over another L4/5 of L5/S1 Due to stress fracture/developmental abnormality Adolescents, increased body weight/sports Waddling, low back pain, flat back
72
Treatmeant of spondylolisthesis
Rest, physio | Stabilisation, reduction

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