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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
How is transient synovitis diagnosed?
Kocher criteria | Ultrasound +/- aspiration
26
Why is septic arthritis a surgical emergency?
High bacterial load Destruction of joint due to proteolytic enzymes Osteonecrosis due to pressure
27
How will septic arthritis present?
Rapid onset, unable to bear weight, hip flexed/externally rotated, severe pain, pyrexia
28
Describe the pathophysiology of septic arthritis
Direct inoculation from trauma Haematogenous spread Extension from adjacent bone - osteomyelitis
29
How is septic arthritis diagnosed?
Blood test and culture Kocher criteria Radiographs Ultrasound and aspiration
30
How is septic arthritis treated?
Open surgical washout | Antibiotics
31
Name three knee problems that can present in kids
Extensor Mechanism problems Adolescent knee pain Osteochondritis Dissecans Meniscal problems
32
Describe patellar tendonitis
Jumper's knee - self limiting but may require physio
33
Describe apophysitis
Inflammation of a growing tubercle where tendon attaches due to repetitive strain
34
Name the apophysitis depending on which tubercle
Tibial - Osgood Schlatter's | Inferior pole of patellar - Sinding-Larsen- Johanssen
35
What is patellofemoral dysfunction associated with?
Muscle imbalance Ligamentous laxity Skeletal predisposition - genu valgum, wide hips, femoral neck anteversion Softening of hyaline cartilage - chondromalacia
36
If patellofemoral dysfunction persists what can be done?
Surgery to shift forces on the patella
37
What is osteochondritis dissecans?
Fragment of cartilage with some bone breaks off the surface of the joint
38
Where does osterochondritis dissecans most commonly occur?
Medial femoral condyle of the knee
39
How does osteochondritis dissecans present?
Pain, effusion, locking
40
How is osteochondritis dissecans diagnosed and treated?
MRI | Surgery to remove fragments or fix lesions
41
What meniscal tears commonly occur in kids?
Peripheral | Bucket handle
42
Define cerebral palsy
Non-progressive damage to the encephalon occurring before the growth of the CNS is complete at age 3
43
Name the causes of cerebral palsy
``` Genetic Brain malformation Intrauterine infection Prematurity Intra-cranial haemorrhage Hypoxia Meningitis Problems during labour ```
44
Name three types of cerebral palsy
Spastic Ataxic Athetoid
45
How does spastic CP arise?
Loss of LMN inhibition due to damage to UMN - hyperreflexia - clonus - spasticity - co-contraction
46
Describe ataxic CP
Affects cerebellum reducing co-ordination and balance
47
Describe athetoid CP
Affects extrapyramidal motor system, pyramidal tract and basal ganglion resulting in speech and ton problems
48
How does CP affect the spine?
Can affect lung function | Scoliosis
49
What treatment is available for CP?
Botox, baclofen Physio, splints Surgery
50
What disease is tip toe walking associated with?
Autism
51
What is club feet?
Structural deformity more common in males. Abnormal alignment of foot joints Corrected by ponseti technique
52
What is rocker bottom feet?
Opposite to club foot and treatment is the same but in reverse ponseti technique
53
What are growing pain red flags?
``` Asymmetry Localised Rapid onset Persisting limp Not thriving Worsening ```
54
What is spina bifida?
Congenital disorder where two halves of the posterior vertebral arch fail to fuse
55
What causes spina bifida?
Low folic acid Family history Medications
56
Name the two types of spina bifida
Occulta | Cystica
57
Describe spina bifida occulta
High arched foot Clawing of toes Dimple/tuft over defect Neurological symptoms
58
Describe spina bifida cystica - name two types
Contents of the vertebral canal herniate through defect Meningocele - herniation of meninges Myelomeningocele - meninges and spinal cord/cauda equina
59
How is spina bifida cystica managed?
Defect closed within 48 hours of birth Treat hydrocephalus with shunt Correct scoliosis, hip and contractures by surgery
60
What is another name for osteogenesis imperfecta?
Brittle bone disease
61
What is OI?
Defect of the maturation and organisation of type 1 collagen
62
What are the features of OI?
Multiple fractures Short stature Blue sclera Loss of hearing
63
How do skeletal dysplasias arise?
Due to genetic error resulting in abnormal development of bone/connective tissue
64
What is achondroplasia?
Disproportionately short limbs, prominent forehead and widened nose. Joints are lax.
65
Name four connective tissue disorders
Joint laxityy Marfan's Elher Danlos Down Syndrome
66
What are the associated features of Marfans?
``` Scoliosis High arched palate Flattening of the chest Eye problems Cardiac disease ```

MSK (22 decks)

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