Paeds Orthopaedics Flashcards
What causes Erb’s palsy?
Compression of C5 + C6 resulting in loss of muscle function + internal rotation of humerus
What condition is associated with classic waiter’s tip palsy?
Erb’s palsy
What is the prognosis of Erb’s palsy?
What should be done to aid remission?
How is remission observed?
Very good (80-90%)
Physio can be used to prevent contractures
Return of function of bicep muscle by 6 months
What is the name for the condition which affects C8 + T1 and causes failure in flexion of hand, resulting in palsy with wrist dominant and fingers hanging? (look at onenote for pics)
Klumpke’s palsy (rarer than Erb’s palsy)
What condition is caused by defect in type 1 collagen in bone?
Osteogenesis imperfecta (brittle bone disease)
What condition is associated with multiple fractures in childhood, short stature and blue sclera?
Osteogenesis imperfecta
What is the medical term for dwarfism?
What is the most common type?
Skeletal dysplasia
Achondroplasia
What type of mutuation results in Marfan’s syndrome?
How does this patient present?
Fibrillin gene (like one big fibre - long and stretched)
V tall with abnormally long limbs and fingers and toes
Abnormal shaped chest
?Scoilosis
What condition is associated with abnormal elastin and collagen formation?
It leads to profound HYPER MOBILITY and EASY BRUSING
What type of collagen is affected?
What mode of inheritance is it?
What is their skin like?
What tool is used to score for hypermobility?
Ehlers-Danlos syndrome
Type III
Autosomal dominant
Mega stretchy and often bruised
Beighton score
Duchenne muscular dystrophy results in early death in 20s.
What is one of the first signs of the condition?
Gower’s sign (look at one note)
Boy will struggle to walk and go up stairs due to muscle weakenss
What condition is caused by dystrophin gene defect (which causes muscle weakness)?
What kind of genetic inheritance is this?
X-linked (affects only boys)
Duchenne muscular dystrophy
How is Duchenne muscular dystrophy diagonsed?
High levels of calcium phosphokinase
Abnormal muscle biopsy
By what age would a boy will duchenne muscular dystrophy stop walking all together?
10 y/o
What is clubfoot’s proper name?
Taliques equinovarus
Clubfoot is valgus or varus?
Varus - most distal part of foot is pointing towards midline
(like walking how I sometimes stand on my feet)
Who is more commonly affected by clubfoot? Boys or girls?
Boys - twice as likely
What technique is used to correct clubfoot?
What must children wear until they are 3-4 years old every night to prevent recurrence?
Ponesti technique (plaster casts)
Brace and boots
What causes cerebral palsy?
By what age would onset occur?
Injury to developing brain
Onset before 2-3 years
What is the treatment for patellar tendonitis (Jumper’s knee)?
Usually self-limiting and requires rest
What tests are used to test for developmental dysplasia of the hip?
What should be done after this?
Barlow - adduct knees together and push posteriorly (pop out hip)
Ortolani - abduction out and anterior displacement (pops hip back in)
<4-6 months - USS
>4-6 months - Xray
(femoral head epiphysis not ossified until then)
Under what circumstances is open surgery of the hip required in DDH?
If dislocation is persistent >18mnths
What is the commonest cause of hip pain in childhood?
What does it often occur after?
Transient synovitis of the hip
Post URTI
How does a child with transient synovitis of the hip present?
How is it managed?
Limp/reluctance to weight bear on affected side
Short course of NSAIDs and rest
What is SUFE?
Describe it
Slipped upper femoral epiphysis
Femoral head slips inferiorly to the femoral neck along the growth plate
How may a patient first present with SUFE?
Isolated knee pain (that’s why always do hip examination)
Loss of internal rotation
What condition causes idiopathic oestochondritis of femoral head resulting in potential collapse due to fracture?
Perthe’s Disease
A patient presents with a Trendellenburg Gait. For each of the following type of patient, identify the most likely cause.
- Baby 1-5 years old
- Short boy, 6 yo, v active
- Overweight 14yo boy
Baby - DDH
V active boy - Perthe’s disease
Overweight boy - SUFE (slipped upper femoral epiphysis)
How is Perthe’s disease managed?
Regular Xray
How is SUFE managed?
with urgent surgery to pin femoral head and neck
What kind of flat feet is suggestive of a bone abnormality?
Fixed flat feet - always flat even not on weight bearing
What toe is most commonly affected in curly toes?
What should be done about it?
5th metatarsal
Just left - only in severe cases in adolescents is surgery indicated
What might a child with intoeing comment on about shoes?
They go through shoes super quick
Also clumsy
What problem at the hip can cause intoeing?
Femoral neck anteversion
Neck of femur being further forward than should be
In a primary care setting If a patient presents with knee pain and a loss of internal rotation which makes you suspect SUFE. What should you do?
Immediate referral to hospital for urgent surgery
