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MSK > Paeds Orthopaedics > Flashcards

Paeds Orthopaedics Flashcards

1
Q

Define short stature

A

Heigh < 3rd centile

Most will not have a pathological reasons

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2
Q

Name five normal variations in kids

A 
Knee alignment 
Rotational Profile 
Flat feet 
Curly Toes 
Cavus Feet
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3
Q

Describe the natural progression of knee alignment

A

Children at birth have varus knees which become neutrally aligned at 14 months progressing to 10-15degrees valgus at 3 years old

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4
Q

When is genu varum abnormal?

A

Abnormal if unilateral, >2SD from mean, short stature, painful

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5
Q

What can cause genu varum?

A 
Skeletal dysplasia 
Rickets 
Tumours 
Trauma - physical injury 
Blounts disease (arrest of medial tibial physis)
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6
Q

When is genu valgum abnormal?

A

Asymmetrical, >2SD, painful, intermalleolar distance >8cm age 11

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7
Q

What can cause genu valgum?

A

Tumours, rickets, neurofibromatosis, idiopathic

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8
Q

Name three variations in rotational profile

A

Intoeing
Femoral neck anteversion
Internal tibial torsion
Metatarus adductus

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9
Q

Describe flexible flat feet

A

Arch forms with dorsiflexion usually due to ligamentous laxity/tightness gastrosoleous complex

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10
Q

Describe fixed flat feet

A

Flat regardless of load/flexion implies underlying bone abnormality

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11
Q

What is tarsal coalition?

A

Bones of hind foot have an abnormal bony cartilaginous connection
- stand on hip toes ankle will move in

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12
Q

What is developmental hip dysplasia?

A

Subluxation or dislocation of hip during perinatal period affects the joint development - more common in girls and left

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13
Q

State the risk factors for hip dysplasia?

A 
Family History 
Breech 
First Born 
Congenital disorders 
Hypermobility due to relaxin receptors 
Oligohydramnios 
Down's syndrome
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14
Q

How is hip dysplasia diagnosed?

A

Examination
Ultrasound
Ortolani test
Barlow test

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15
Q

What are ortolani and barlow tests?

A

Ortolani - reducing a dislocated hip with abduction and displacement
Barlow - adduction and depression dislocates a susceptible hip

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16
Q

How is hip dysplasia managed?

A

Pavlik harness
Open reduction
Surgery if late presentation

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17
Q

What will a late presentation of hip dysplasia look like?

A

Trendelenburg gait

Avascular necrosis

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18
Q

What is meant by SUFE?

A

Slipped Upper Femoral Epiphysis

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19
Q

What is SUFE?

A

Displacement thought the growth plate with the epiphysis slipping down and back

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20
Q

What are the risk factors for SUFE?

A

Obesity
Hypothyroidism
Male
Renal Disease

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21
Q

How is SUFE diagnosed?

A

Knee pain
Antalgic gait, short/rotated lower limb
Loss of internal rotation

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22
Q

How is SUFE treated?

A

Surgery - pin or replacement

Severe cases may require osteotomy

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23
Q

What is transient synovitis?

A

Inflammation of the synovial often secondary to viral illness

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24
Q

How will transient synovitis present?

A

Limp and hip/groin pain
Flexed/externally rotated
Apyrexial
Resisted range of movement

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25
Q

How is transient synovitis diagnosed?

A

Kocher criteria

Ultrasound +/- aspiration

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26
Q

Why is septic arthritis a surgical emergency?

A

High bacterial load
Destruction of joint due to proteolytic enzymes
Osteonecrosis due to pressure

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27
Q

How will septic arthritis present?

A

Rapid onset, unable to bear weight, hip flexed/externally rotated, severe pain, pyrexia

28
Q

Describe the pathophysiology of septic arthritis

A

Direct inoculation from trauma
Haematogenous spread
Extension from adjacent bone - osteomyelitis

29
Q

How is septic arthritis diagnosed?

A

Blood test and culture
Kocher criteria
Radiographs
Ultrasound and aspiration

30
Q

How is septic arthritis treated?

A

Open surgical washout

Antibiotics

31
Q

Name three knee problems that can present in kids

A

Extensor Mechanism problems
Adolescent knee pain
Osteochondritis Dissecans
Meniscal problems

32
Q

Describe patellar tendonitis

A

Jumper’s knee - self limiting but may require physio

33
Q

Describe apophysitis

A

Inflammation of a growing tubercle where tendon attaches due to repetitive strain

34
Q

Name the apophysitis depending on which tubercle

A

Tibial - Osgood Schlatter’s

Inferior pole of patellar - Sinding-Larsen- Johanssen

35
Q

What is patellofemoral dysfunction associated with?

A

Muscle imbalance
Ligamentous laxity
Skeletal predisposition - genu valgum, wide hips, femoral neck anteversion
Softening of hyaline cartilage - chondromalacia

36
Q

If patellofemoral dysfunction persists what can be done?

A

Surgery to shift forces on the patella

37
Q

What is osteochondritis dissecans?

A

Fragment of cartilage with some bone breaks off the surface of the joint

38
Q

Where does osterochondritis dissecans most commonly occur?

A

Medial femoral condyle of the knee

39
Q

How does osteochondritis dissecans present?

A

Pain, effusion, locking

40
Q

How is osteochondritis dissecans diagnosed and treated?

A

MRI

Surgery to remove fragments or fix lesions

41
Q

What meniscal tears commonly occur in kids?

A

Peripheral

Bucket handle

42
Q

Define cerebral palsy

A

Non-progressive damage to the encephalon occurring before the growth of the CNS is complete at age 3

43
Q

Name the causes of cerebral palsy

A 
Genetic 
Brain malformation 
Intrauterine infection 
Prematurity 
Intra-cranial haemorrhage 
Hypoxia 
Meningitis 
Problems during labour
44
Q

Name three types of cerebral palsy

A

Spastic
Ataxic
Athetoid

45
Q

How does spastic CP arise?

A

Loss of LMN inhibition due to damage to UMN

  • hyperreflexia
  • clonus
  • spasticity
  • co-contraction
46
Q

Describe ataxic CP

A

Affects cerebellum reducing co-ordination and balance

47
Q

Describe athetoid CP

A

Affects extrapyramidal motor system, pyramidal tract and basal ganglion resulting in speech and ton problems

48
Q

How does CP affect the spine?

A

Can affect lung function

Scoliosis

49
Q

What treatment is available for CP?

A

Botox, baclofen
Physio, splints
Surgery

50
Q

What disease is tip toe walking associated with?

A

Autism

51
Q

What is club feet?

A

Structural deformity more common in males.
Abnormal alignment of foot joints
Corrected by ponseti technique

52
Q

What is rocker bottom feet?

A

Opposite to club foot and treatment is the same but in reverse ponseti technique

53
Q

What are growing pain red flags?

A 
Asymmetry 
Localised 
Rapid onset 
Persisting limp 
Not thriving 
Worsening
54
Q

What is spina bifida?

A

Congenital disorder where two halves of the posterior vertebral arch fail to fuse

55
Q

What causes spina bifida?

A

Low folic acid
Family history
Medications

56
Q

Name the two types of spina bifida

A

Occulta

Cystica

57
Q

Describe spina bifida occulta

A

High arched foot
Clawing of toes
Dimple/tuft over defect
Neurological symptoms

58
Q

Describe spina bifida cystica - name two types

A

Contents of the vertebral canal herniate through defect
Meningocele - herniation of meninges
Myelomeningocele - meninges and spinal cord/cauda equina

59
Q

How is spina bifida cystica managed?

A

Defect closed within 48 hours of birth
Treat hydrocephalus with shunt
Correct scoliosis, hip and contractures by surgery

60
Q

What is another name for osteogenesis imperfecta?

A

Brittle bone disease

61
Q

What is OI?

A

Defect of the maturation and organisation of type 1 collagen

62
Q

What are the features of OI?

A

Multiple fractures
Short stature
Blue sclera
Loss of hearing

63
Q

How do skeletal dysplasias arise?

A

Due to genetic error resulting in abnormal development of bone/connective tissue

64
Q

What is achondroplasia?

A

Disproportionately short limbs, prominent forehead and widened nose. Joints are lax.

65
Q

Name four connective tissue disorders

A

Joint laxityy
Marfan’s
Elher Danlos
Down Syndrome

66
Q

What are the associated features of Marfans?

A 
Scoliosis 
High arched palate 
Flattening of the chest 
Eye problems 
Cardiac disease

MSK (22 decks)

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