S3L3: Spina Bifida part 2 Flashcards
severe form of Congenital Hip Dislocation
A. Teratologic/antenatal dislocation
B. Congenital hip dislocation
C. Acetabular dysplasia
D. Congenital subluxation
E. Unstable hip
A
completely out; may or may not be reduced
A. Teratologic/antenatal dislocation
B. Congenital hip dislocation
C. Acetabular dysplasia
D. Congenital subluxation
E. Unstable hip
B
shallow acetabulum in x-rays 3-4 months
A. Teratologic/antenatal dislocation
B. Congenital hip dislocation
C. Acetabular dysplasia
D. Congenital subluxation
E. Unstable hip
C
neither dislocated nor seated in the acetabulum
A. Teratologic/antenatal dislocation
B. Congenital hip dislocation
C. Acetabular dysplasia
D. Congenital subluxation
E. Unstable hip
D
femoral head can be dislocated
A. Teratologic/antenatal dislocation
B. Congenital hip dislocation
C. Acetabular dysplasia
D. Congenital subluxation
E. Unstable hip
E
Identify the wrong statements
Pathology of congenital hip dislocation
- Hip jt. in FABER
- The acetabulum becomes shallow, and the roof slopes
- The femoral head displaced downward and forward, shows some flattening
- The adductor group becomes shortened, and contracted
- Hip jt. in ExAddER
The femoral head displaced upward and
backward, shows some flattening
test for dislacatable hip
hip add
A. Barlow
B. Ortolani
C. Pistoning/telescoping/dupuytren
D. Galleazi / Allis
A
One knee is higher than the other
A. Barlow
B. Ortolani
C. Pistoning/telescoping/dupuytren
D. Galleazi / Allis
D
Upward and downward force
Inc. skin fold
Flex hip and knee to 90 degrees and then push the femur down and lift up
A. Barlow
B. Ortolani
C. Pistoning/telescoping/dupuytren
D. Galleazi / Allis
C
Test for relocatable hip
Hip abd
A. Barlow
B. Ortolani
C. Pistoning/telescoping/dupuytren
D. Galleazi / Allis
B
d/t tight hip adductors mimics Trendelenburg gait
A. Trendelenburg sign / Waddling gait
B. Abduction Lurch
C. Hilgenreiner Line
D. Shenton’s Line
E. Acetabular Index
A
d/t tight hip adductors
A. Trendelenburg sign / Waddling gait
B. Abduction Lurch
C. Hilgenreiner Line
D. Shenton’s Line
E. Acetabular Index
B
horizontal line through the triradiate cartilages
A. Trendelenburg sign / Waddling gait
B. Abduction Lurch
C. Hilgenreiner Line
D. Shenton’s Line
E. Acetabular Index
C
obturator- coxofemoral line
A. Trendelenburg sign / Waddling gait
B. Abduction Lurch
C. Hilgenreiner Line
D. Shenton’s Line
E. Acetabular Index
D
angle made between the horizontal line through the triradiate cartilages & oblique line drawn from the medial to the outer edge of its roof
A. Trendelenburg sign / Waddling gait
B. Abduction Lurch
C. Hilgenreiner Line
D. Shenton’s Line
E. Acetabular Index
E
H-shaped malleable splint
A. Von Rosen
B. Ilfeld
C. Pavlik Harness
D. Frejka Pillow
A
consists of two aluminum thigh bands fastened to a stainless steel crossbar with swivel joints.
A. Von Rosen
B. Ilfeld
C. Pavlik Harness
D. Frejka Pillow
B
presence of straps
A. Von Rosen
B. Ilfeld
C. Pavlik Harness
D. Frejka Pillow
C
uses a pillow to position the hip in abduction
A. Von Rosen
B. Ilfeld
C. Pavlik Harness
D.Frejka Pillow
D
Identify the wrong statements about treatment
-Conservative treatment done for Spina Bifida: casting
- Traction, Plaster cast – over seven months
- Surgical resection of adductor muscles
- Open reduction: between 18mos-2 yrs ant iliofemoral approach
- Redirection of acetabular dome
Conservative treatment done for Spina Bifida: splinting
Traction, Plaster cast – over six months
T/F The following are TREATMENT OVER 6 Y/O
* Severe contractures
- Increasing limp & Disability
- Subluxed hip: more common
- Complications: osteonecrosis of the femoral head, osteoarthritis of the hip
T
tenotomy of iliopsoas tendon for pts. <18mos. of age
A. Ferguson method
B. Chiari’s
C. Salter’s
D. Kirschner
E. Pemberton’s
A
acetabular redirection osteotomy; ant. Iliac crest is opened, a Kirschner wire is placed for six weeks
A. Ferguson method
B. Chiari’s
C. Salter’s
D. Kirschner
E. Pemberton’s
C
lateral pelvis displacement to increase acetabular coverage
A. Ferguson method
B. Chiari’s
C. Salter’s
D. Kirschner
E. Pemberton’s
B
acetabular redirection osteotomy; a block of bone from iliac crest is wedged in the osteotomy line
A. Ferguson method
B. Chiari’s
C. Salter’s
D. Kirschner
E. Pemberton’s
E
Which of the ff. Are CONGENITAL KNEE DISLOCATION
A. Congenital Genu Recurvatum
B. Partial or Complete Anterior Displacement of the Tibial Condyles on those of the Femur
C. All
D. None
C
T/F about CONGENITAL KNEE DISLOCATION
- Clinical Picture:
Contracture of the quadriceps
Absent or small patella
Lateral instability of the leg - TREATMENT
Manipulation
Serial casts
TT
Identify the wrong statement about CONGENITAL KNEE DISLOCATION:
- Unknown etiology; F > M, 2:1; usually unilateral
- Shortened Achilles tendon
- Anterior and posterior tibial tendons are contracted in proportion to the degree of varus deformity.
The most striking abnormality is at the
- Talocalcaneonavicular joint /Midtarsal
- Talipes Equinovarus (Clubfoot)
Unknown etiology; M > F, 2:1; usually bilateral
T/F. FOUR CARDINAL POSITIONS: oEquinus
oCalcaneus
oVarus
oValgus
T
T/F. CONGENITAL TALIPES PATHOLOGY:
- lengthened Achilles tendon, contracted ant/post tibial tendons
- most affected joint: TCN
F: shortened Achilles tendon
Identify the wrong statement in CONGENITAL TALIPES CLINICAL PICTURE:
1.The heel is drawn up, the entire foot below the talus is inverted, and the anterior half of the foot is adducted
2.The medial border is concave, and lateral is convex
3.If not corrected before the infant starts to walk, the child suffers from the inability to bear weight normally
4.Kite’s angle / Talocalcaneal angle
N: 10-20 deg
N: 20-30 deg
Aka foot abduction orthosis
A. Denis Browne Splint
B. Ponseti casting
C. Dwyer
D. Turco
E. Evans
A
Manipulation to correct clubfoot
A. Denis Browne Splint
B. Ponseti casting
C. Dwyer
D. Turco
E. Evans
B
calcaneal osteotomy
A. Denis Browne Splint
B. Ponseti casting
C. Dwyer
D. Turco
E. Evans
C
posteromedial release
A. Denis Browne Splint
B. Ponseti casting
C. Dwyer
D. Turco
E. Evans
D
TN joint release with CC resection
A. Denis Browne Splint
B. Ponseti casting
C. Dwyer
D. Turco
E. Evans
E
T/F in CONGENITAL TALIPES
* Order of correction: Forefoot Adduction Subtalar Inversion
- Talocrural PF (follow the correct sequence to avoid rockerbottom deformity)
TT
Identify the wrong statement in TALIPES
CALCANEOVALGUS
- Eversion of the foot, increased DF of the ankle, and lengthening of the Achilles tendon
- first most common
Treatment:
* Mild stretching, corrective casts, Denis-Browne splint (feet in equinovarus position)
Second most common
T/F in METATARSUS
ADDUCTUS
- Consists of adduction of the forefoot at the tarsometatarsal joint
- Metatarsus Primus Adductus - increased adduction of the 1st metatarsal resulting to widening between the 1st & 2nd toes
- One of the most common causes of pigeon toe
- In-toeing may be accentuated by an accompanying internal tibial or femoral torsion
All T
T/F. TREATMENT for METATARSUS
ADDUCTUS include
- Stretching forefoot into abduction while holding hindfoot fully inverted
- Bootee cast
TT
Identify the wrong statement in CONGENITAL CLUB HAND
- Paraxial Radial Hemimelia - congenital absence of radius
- M > F, bilateral, right 2x > left
- marked radial deviation of the hand with shortening of the forearm
- underdeveloped or absent thumb ray, carpal navicular
- the radius is bowed with the concavity directed toward the ulnar side
- absent radial nerve and artery, median nerve rakes over its function
- the wrist joint is unstable
the ulna is bowed with the concavity directed toward the radial side
the wrist joint is stable
T/F TREATMENT IN CONGENITAL CLUB HAND
brace or dynamic splint
Kirschner wire –inserted down the 3rd metacarpal, across the center of the distal ulnar epiphysis, and into the medullary canal of the ulna
TT
Which of The ff are components of congenital absence of ulna
A. Ulnar club hand
B. It’s less frequent
C. Unstable elbow joint
D. All of the above
D
CONGENITAL DEFORMITIES OF TOES AND FINGERS
- flexion contracture of a finger frequently involves both
- shortening of the flexor digitorum sublimis tendons
A. CAMPTODACTYLY
B. MACRODACTYLY
C. SYNDACTYLY
D. POLYDACTYLY
A
CONGENITAL DEFORMITIES OF TOES AND FINGERS
TREATMENT
- early, gradual manipulation into the corrected position
- Use of retention splints
- active exercises
A. CAMPTODACTYLY
B. MACRODACTYLY
C. SYNDACTYLY
D. POLYDACTYLY
A
CONGENITAL DEFORMITIES OF TOES AND FINGERS
Overdevelopment of one or more fingers & toes
Treatment: amputation
A. CAMPTODACTYLY
B. MACRODACTYLY
C. SYNDACTYLY
D. POLYDACTYLY
B
CONGENITAL DEFORMITIES OF TOES AND FINGERS
- congenital webbed finger or toes
- M 2x > F
- hand > foot, ulnar side > radial, thumb is seldom involved
Types:
- Simple: union of the digits consisting of skin & connective tissues only
Complex: includes the bone
A. CAMPTODACTYLY
B. MACRODACTYLY
C. SYNDACTYLY
D. POLYDACTYLY
C
CONGENITAL DEFORMITIES OF TOES AND FINGERS
Treatment:
- separation should be done between 18
- months and 5 years
- ·Lobster hand – severe form of syndactyly
A. CAMPTODACTYLY
B. MACRODACTYLY
C. SYNDACTYLY
D. POLYDACTYLY
C
CONGENITAL DEFORMITIES OF TOES AND FINGERS
- supernumerary digits, maybe a very small skin appendage to a well-developed digit
- often bilaterally and may be combined with syndactyly
A. CAMPTODACTYLY
B. MACRODACTYLY
C. SYNDACTYLY
D. POLYDACTYLY
D
lateral contracture of digits
A. CLINODACTYLY
B. BRACHYDACTYLY
C. POUCE FLOTTANT
A
shortened fingers
A. CLINODACTYLY
B. BRACHYDACTYLY
C. POUCE FLOTTANT
B
rudimentary thumb w/ no or very little
MC
A. CLINODACTYLY
B. BRACHYDACTYLY
C. POUCE FLOTTANT
C
T/F. In ARTHROGRYPOSIS MULTIPLEX
CONGENITA
- incomplete congenital fibrous ankylosis of many or all joints of the limbs
*symmetric, trunk is frequently spared
TT
Identify the wrong statements in Clinical Picture of ARTHROGRYPOSIS MULTIPLEX
CONGENITA
a.Shoulders ER, wrists extended
b.Elbows and knees flexed or extended
c.Hips extended and IR, may be dislocated
d.Patellae absent or dislocated
e. Probable clubfeet
f.Congenital high scapula
g.Sometimes, biceps & brachioradialis are absent l no active flexion of the elbow Contractures do not progress
Shoulders IR, wrists flexed
Hips flexed and ER, may be dislocated
Identify the wrong statement in SPRENGEL’S DEFORMITY
*scapula elevated 1 -4 inches above normal position
*(+) omovertebral bone - osseous bridge between vertebra and scapula
- inferior angle is rotated medially, sometimes bilateral
*smaller scapula, decreased vertical length, increased width
*shortened cervical muscles on the affected side
*Sometimes bilateral, ABDUCTION is greatly restricted, ROTATION NOT AFFECTED
*Surgery before 5 y/o, postural training
All are correct
T/F. Klippel-feil syndrome is the fusion of all or of only the lower cervical vertebrae into one homogenous mass of bone
T
T/F
Clinical Picture of Klippel-feil syndrome includes:
- Low posterior hairline
- Lateral motion is more affected than flexion & extension
- Pterygium Colli or Web neck: trapezius muscle stretch winglike from the mastoid processes to the shoulders
Treatment includes:
Surgery to improve appearance and mobility
TT
T/F about CLEIDOCRANIAL DYSOSTOSIS
·Partial or complete absence of both clavicles
·Delayed ossification of fontanels
·Little disability, no treatment is indicated
All TRUE
