Paeds Orthopaedics

Question 1

What causes Erb’s palsy?

Answer 1

Compression of C5 + C6 resulting in loss of muscle function + internal rotation of humerus

Question 2

What condition is associated with classic waiter’s tip palsy?

Answer 2

Erb’s palsy

Question 3

What is the prognosis of Erb’s palsy?

What should be done to aid remission?

How is remission observed?

Answer 3

Very good (80-90%)

Physio can be used to prevent contractures

Return of function of bicep muscle by 6 months

Question 4

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)

Answer 4

Klumpke’s palsy (rarer than Erb’s palsy)

Question 5

What condition is caused by defect in type 1 collagen in bone?

Answer 5

Osteogenesis imperfecta (brittle bone disease)

Question 6

What condition is associated with multiple fractures in childhood, short stature and blue sclera?

Answer 6

Osteogenesis imperfecta

Question 7

What is the medical term for dwarfism?

What is the most common type?

Answer 7

Skeletal dysplasia

Achondroplasia

Question 8

What type of mutuation results in Marfan’s syndrome?

How does this patient present?

Answer 8

Fibrillin gene (like one big fibre - long and stretched)

V tall with abnormally long limbs and fingers and toes

Abnormal shaped chest

?Scoilosis

Question 9

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?

Answer 9

Ehlers-Danlos syndrome

Type III
Autosomal dominant
Mega stretchy and often bruised

Beighton score

Question 10

Duchenne muscular dystrophy results in early death in 20s.

What is one of the first signs of the condition?

Answer 10

Gower’s sign (look at one note)

Boy will struggle to walk and go up stairs due to muscle weakenss

Question 11

What condition is caused by dystrophin gene defect (which causes muscle weakness)?

What kind of genetic inheritance is this?

Answer 11

X-linked (affects only boys)

Duchenne muscular dystrophy

Question 12

How is Duchenne muscular dystrophy diagonsed?

Answer 12

High levels of calcium phosphokinase

Abnormal muscle biopsy

Question 13

By what age would a boy will duchenne muscular dystrophy stop walking all together?

Answer 13

10 y/o

Question 14

What is clubfoot’s proper name?

Answer 14

Taliques equinovarus

Question 15

Clubfoot is valgus or varus?

Answer 15

Varus - most distal part of foot is pointing towards midline

(like walking how I sometimes stand on my feet)

Question 16

Who is more commonly affected by clubfoot? Boys or girls?

Answer 16

Boys - twice as likely

Question 17

What technique is used to correct clubfoot?

What must children wear until they are 3-4 years old every night to prevent recurrence?

Answer 17

Ponesti technique (plaster casts)

Brace and boots

Question 18

What causes cerebral palsy?

By what age would onset occur?

Answer 18

Injury to developing brain

Onset before 2-3 years

Question 19

What is the treatment for patellar tendonitis (Jumper’s knee)?

Answer 19

Usually self-limiting and requires rest

Question 20

What tests are used to test for developmental dysplasia of the hip?

What should be done after this?

Answer 20

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)

Question 21

Under what circumstances is open surgery of the hip required in DDH?

Answer 21

If dislocation is persistent >18mnths

Question 22

What is the commonest cause of hip pain in childhood?

What does it often occur after?

Answer 22

Transient synovitis of the hip

Post URTI

Question 23

How does a child with transient synovitis of the hip present?

How is it managed?

Answer 23

Limp/reluctance to weight bear on affected side

Short course of NSAIDs and rest

Question 24

What is SUFE?

Describe it

Answer 24

Slipped upper femoral epiphysis

Femoral head slips inferiorly to the femoral neck along the growth plate

Question 25

How may a patient first present with SUFE?

Answer 25

Isolated knee pain (that’s why always do hip examination)

Loss of internal rotation

Question 26

What condition causes idiopathic oestochondritis of femoral head resulting in potential collapse due to fracture?

Answer 26

Perthe’s Disease

Question 27

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

Answer 27

Baby - DDH
V active boy - Perthe’s disease
Overweight boy - SUFE (slipped upper femoral epiphysis)

Question 28

How is Perthe’s disease managed?

Answer 28

Regular Xray

Question 29

How is SUFE managed?

Answer 29

with urgent surgery to pin femoral head and neck

Question 30

What kind of flat feet is suggestive of a bone abnormality?

Answer 30

Fixed flat feet - always flat even not on weight bearing

Question 31

What toe is most commonly affected in curly toes?

What should be done about it?

Answer 31

5th metatarsal

Just left - only in severe cases in adolescents is surgery indicated

Question 32

What might a child with intoeing comment on about shoes?

Answer 32

They go through shoes super quick

Also clumsy

Question 33

What problem at the hip can cause intoeing?

Answer 33

Femoral neck anteversion

Neck of femur being further forward than should be

Question 34

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?

Answer 34

Immediate referral to hospital for urgent surgery