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YR3S2- PM4 > wk 5 - rotational > Flashcards

wk 5 - rotational Flashcards

1
Q

what causes positional deformities in fetus

A

intrinsic cause:
-neuromuscular disorders causing decreased fetal movement
-renal disease resulting in decreased production of amniotic fluid and oligohydramnios, this increases fetal compression from outside forces

extrinsic cause:
-things that cause fetal crowding and restrict fetal movement

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2
Q

2 elements that cause deformations to fetus

A
  1. restricted fetal movement
  2. fetal compression

fetal movement is required for normal musculoskeletal development in extremities

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3
Q

during what period do external compression increase and amniotic fluid decrease

A

third trimester where deformities most commonly arise

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4
Q

developmental dysplasia of the hip

A

abnormal development/ contact of the acetabulum and proximal femur causing mechanical instability of the hip joint

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5
Q

risk factors for developmental dysplasia of hip

A

-female gender
-breech position (baby hasnt turned in womb)
-family history

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6
Q

assessments of dysplasia

A
  1. ortolani maneuver
  2. barlow maneuver
  3. galeazzi test
    4.US/ radiographs after 4-6months of age (before this time the structures are unossified)
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7
Q

what are rotational deformities of the legs

A

internal tibial torsion
external tibial torsion
physiological genu varum

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8
Q

internal tibial torsion caused by and causes what?

A

caused by intauterine (womb) positioning, typically bilateral
when its unilateral presentation its usually the left leg for unknown reasons

causes in toeing
it can be associated with metatarsus adductus and genu varum

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9
Q

does internal tibial torsion require treatment

A

usually resolves after normal growth, intervention isn’t usually required

surgery is only required for an older child where there is obvious functional deformity

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10
Q

external tibial torsion causes and what does it cause

A

caused by intrauterine positioning

causes out toeing

it is more likely to persist throughout teenage years than internal

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11
Q

genu varum what causes it

A

caused by womb positioning
caused by external rotation at the hip due to tight posterior hip capsule and internal tibial torsion

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12
Q

treatment for genu varum

A

usually resolves spontaneously but must be differentiated from pathological caues like blounts disease or rickets

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13
Q

what could genu varum also be? Dx:

A

blounts disease
rickets

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14
Q

rotational deformities of the feet

A

metatarsus adductus
positional calcaneovalgus
club foot
skew foot

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15
Q

metatarsus adductus what is it and is it bilateral or uni

A

forefoot that is adducted at the tarsometatarsal joints in relation to hindfoot that remains in a normal position

often bilateral, if unilateral occurs more on left for unknown reasons

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16
Q

whats the most common cause of intoeing in toddlers

A

internal tibial torsion

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17
Q

whats the most common cause of intoeing in infants

A

metatarsus adductus

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18
Q

blecks scale for classifiying matarasus adductus

A

drawing a line straight down the middle of the heel to toes:

Normal – bisection of 2nd Digit
* Mild – Bisection of 3rd Digit
* Moderate – Between 3rd/4th Digits
* Severe – Between 4th/5th Digit

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19
Q

if youre going to get a radiograph what do u need to remember

A

ossified bones

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20
Q

primary ossifications present at birth

A

visible on x ray at birth
calc
talus
cuboid
metarsals
phalanges

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21
Q

primary ossifications developed after birth and when

A

visible on x ray
lateral cuneiform- 1st year
medial cuneiform- 3rd year
intermediate cuneiform- 4th year
navicular- 4th year

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22
Q

what could metatarsus adductus also be? Ddx:

A

skewfoot

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23
Q

what are u looking for on radiograph to diagnose metatarsus adductus

A

medial deviation of 1st met from the talus - first metatarsal line

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24
Q

skewfoot shows what on a radiograph

A

the same as metatarsus adductus: medial deviation of 1st met from the talar fitst met angle

AS well as

valgus deformity of the hindfoot, with a talocalconeal angle more than 35 degs on AP radiograph and 45 degs on lateral radiograph

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25
Q

what digit deformity do MTA typically have

A

HAV

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26
Q

what do you need to find out about an metatarsus adductus

A

positional - using blecks classification
flexibility- rigid, semi rigid, flexible

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27
Q

grading flexibility of metarasus adductus

A

grade 1 (flexible)- deformity correctable past midline
grade 2- (semi rigid)- deformity correctable to midline
grade3 - (rigid)- deformity cannot be corrected to midline

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28
Q

treatment for mild blecks scale/flexible MA

A

nil

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29
Q

treatment for mod blecks scale/flexible MA at 4-8months, 8-10 months, walking

A

4-8months: brace/splint
8-10months: casting and SLS/night splint
walking: 1-2 casts and SLS, orthoses and night splint

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30
Q

treatment for severe blecks scale and semi rigid MA

A

4-8months: serial casts followed by abduction orthoses /night splint

8-10months: casting and SLS/night splint

walking: 1-2 casts and SLS, orthoses and night splint

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31
Q

treatment for skew foot

A

footwear, orthoses, surgery

32
Q

SLS stands for

A

straight last shoes

33
Q

if you dont treat MA what could happen

A

deformities
-metatarsus primus vaurs (abduction of great toe)
-hallux valgus
-hammer toes
-medial tibial torsion
-in toeing

functional
tripping
shoe fitting
aesthetic concerns
plantar pressure differences

34
Q

flexible metatarsus adductus, do u need to treat?

A

good evidence that you dont need to and that the child will continue to derotate as they get older

recommendations could be stretching, SLS

35
Q

can a rigid MA get better after the 1st year?

A

low evidence showing it gets better as bones start to ossify

36
Q

what is serial casting

A

cast below the knee holding the forefoot in a rectus position

cast is changed every 1-2 weeks for a period of up to 6-12weeks

37
Q

what is serial casting good for

A

semi rigid MA
and rigid MA if <1 years old

38
Q

cons of serial casting

A

-time, multiple visits
-skin irritation/cut flow off
-child not able to give feedback
-emotional trauma/quality of life

39
Q

what is weaton brace and what is it good for

A

mod to severe MA

piece of thermoplastic that is moulded to the desired correction of the patients foot

worn for 24 hours a day until correction then suggested 4 weeks of night use to maintain

40
Q

pros and cons of wheaton brace

A

pros
-dont need to revisit clinic
-can remove for hygiene
-same results as serial casting

cons
-non weightbearing device

41
Q

what is bebax orthotics, how are they used, when is correction seen

A

leather shoe with two parts thats adjusted with a multidirectional hinge

1.worn 21-24hours at 20-25degrees outflare (4-6weeks)
2. increased to 45 degress outflare for 16-18hours per day

correction is seen around 3 months

42
Q

bebax orthotics good for

A

semi rigid and rigid MA early in life

43
Q

pros and cons of bebax orthotics

A

pros
-less expensive than casting
-can be adjusted

cons
-requires high parent paritcipation
-not for weightbearing (6-12 months or earlier is good for)

44
Q

what is corrective bandage

A

starts with corrective manipulation to flex retracted muscles of foot for 5 days per week for 15mins

after which, cotton bandage is applied from toe to knee.

45
Q

what is corrective bandage good for

A

semi rigid MA in 1st month of life

46
Q

pros and cons of corrective bandage

A

pros
-cost effective
-can be removed

cons
-training in manipulation
-low efficacy
-best done in 1st month of life

47
Q

what is a denis browne bar

A

holds foot in externally rotated position

48
Q

what is denis browne bar good for

A

all types of MA, skewfoot, gold standard for maintaining correction after casting for talipes equino varus

49
Q

pros and cons of denis browne bar

A

pros
-good for babies that sleep in prone position
-good for babies with internal tibial torsion also

cons
-used with caution as holding foot in rearfoot valgus position so there is increased risk of having flat foot deformity after treatment

50
Q

what are reverse last shoes

A

opposite shoe wearing

51
Q

what do reverse last shoes cause

A

Hallux valgus deformity

52
Q

other footwear devices for MA

A

UCBL- high heel cup, medial/lateral flange

SMO- around lat and medial mall

not enough studies done to prove efficiacy

53
Q

what is a turtle brace and what could it help with

A

heat mouldable thermoplastic cast that allows walking on

similar to serial casting but removable and can be walked on

54
Q

talipes calcaneovalgus feet are

A

hyperdorsiflexion of the foot with abduction of the forefoot which often results in the forefoot resting on the anterior surface of the lower leg

55
Q

what is associated with calcaneovalgus feet and what do you need to rule out and why

A

associated with external tibial torsion

Calcaneovalgus resolves spontaneously on its own usually but needs to be differentiated from more severe conditions like congential vertical talus

56
Q

talipes equino varus (clubfoot)

A

foot excessively plantarflexed with forefoot swinging medially and soles facing inward

57
Q

types of clubfoot

A
  1. positional (breech)
    2.congential -most common
  2. syndromic
58
Q

treatment for clubfoot

A
  1. serial casting with denis browne bar at night to maintain correction
  2. surgery (tenotomy)- lengthening of achilles tendon
59
Q

causes of intoeing in infants, toddler and children

A

infants (1-2): MTA
toddler (2-3): internal tibial torsion
children (3 or mroe): femoral torsion

also CP is a common cause

60
Q

if a child is intoeing or outtoeing what examinations would you complete

A

-hip internal/external rotation: lateral range (internal rotation) should be greater than medial (external rotation), at age 2 its symmetrical
test in flexion and extension to check for bony or soft tissue

-femoral torsion (ryders test)

-knee reduced extension
observe position of patella in stance and gait
0-2yrs- laterally rotated
2 years and more - straight

-tibial torsion
1. (foot thigh angle) measuring longitudinal angle of thigh and foot

more than 30deg is external tibial torsion, less than 0deg is internal tibial torsion

  1. transmalleolar axis
    -measuring longitudinal angle of thigh and

feet- blecks/ruler measurement on side of foot

61
Q

ryders test does what

A

tests femoral torsion

62
Q

foot thigh angle tests what

A

tibial torsion

63
Q

trans malleolar axis tests what

A

tibial torsion

64
Q

if the patella is medially rotated then

A

there is a femur component thats cause intoeing

65
Q

if the patella is straight and feet adducted then it could be

A

medial genicular bias
medial tibial torsion
psudeomalleolar torsion
MTA

66
Q

if knee extension is limited and foot is adducted what could this be due to

A

tight hamstrings
tight gastroc
tight ligaments

67
Q

Difference between tibial torsion and medial genicular bias during gait

A

in-toe due to medial tibial torsion is usually consistent whereas, in-toeing
due to medial genicular position tends to be more variable (step to step

68
Q

medial genicular bias is caused by, at what age should become symmetrical

A

intrauterine confinement, should become symetrical by age 3 but may be maintained if
1. severe
2. postures perpetuate position
3. neuromotor dysfunction impedes normal modelling

69
Q

most common causes of out toeing

A
  1. external rotation contracture of hip
  2. External tibial torsion
  3. femoral retroversion (rare)
70
Q

external rotation contracture of the hip clinical features

A
  • bilateral and symmetrical out toeing
    -standing/walking both patella and feet are externally pointing out
  • increased hip external rotation compared with internal hip rotation

resolves around 12 months of age

71
Q

external tibial torsion caused by clinical features

A

caused by intrauterine positioning

-often unilateral and more common on right side
-standing/walking foot externally rotated (external foot progression angle)
-medial mall anterior to lateral mall while seated with thigh in front of hip joint and knee straight ahead
-FTA is external

72
Q

femoral retroversion clinical features

A

rare

-obese children
-bilateral an symmetrical out toeing
-external foot and patella progression
-increased hip external rotation compared to internal
-may be assocaited with OA, stress fractures and slipped capital femoral epiphysis

73
Q

treatment for external rotation contracture of hip

A

reassure parent that it is physiological and resolves spontaneously

74
Q

treatment for femoral tretoversion

A

unlikely to resolve spontaneously

derotational osteotomy may be indicated in patients with hip pain, severe gait disturbances or deformity

75
Q

external tibial torsion treatment

A

most can be managed with observation and parental reassurance

derotational tibial osteotomy is the only effective treatment but should only be for patients with knee pain, severe deformity and an external FTA greater than 40 degrees

YR3S2- PM4 (12 decks)

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