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LOCO2 > Bone and Joint Problems in Children > Flashcards

Bone and Joint Problems in Children Flashcards

1
Q

What are the common bone/joint problems in children?

A
  • flat foot
  • club foot
  • toe walking
  • congenital dysplasia of the hip
  • Perthe’s
  • Blount’s disease
  • Osgood-Schlatter
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2
Q

What is flat-foot?

A
  • most babies born with it
  • develop arches in growth
  • top of foot more rounded
  • flexed toes
  • bottom flatter with slight medial arch and no lateral arch
  • some arch never develops
  • notice weak ankles
  • turn ankles inwards
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3
Q

What is the treatment for flat foot?

A
  • orthotics = mould as bones are soft so will easily grow into it
  • surgery
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4
Q

What is toe walking?

A
  • common in toddlers as they learn to walk
  • habitual
  • can shorten plantar flexors as get used to working at short length
  • disappears by age of 2
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5
Q

What is the differential diagnosis of toe walking?

A
  • cerebral palsy (hypertonia)
  • DMD
  • nervous system problems
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6
Q

What is the treatment of toe walking?

A
  • cast foot/ankle for 6 weeks to stretch calf muscles
  • physiotherapy
  • surgery to release tight calf muscles
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7
Q

What is Club foot?

A
  • fixed varus (inwards) and equinus deformity

- more males

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8
Q

What are the causes of club foot?

A
  • constraint development problem (oligohydramnios or breech presentation)
  • genetic syndromes (CT disorder, Edwards, family history)
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9
Q

What is the treatment for club foot?

A
  • ponseti method (series of plasters for 12 weeks, up to 4 years)
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10
Q

What is congenital hip dysplasia?

A
  • present at birth
  • associated with clubfoot and scoliosis
  • females more common (hormone related)
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11
Q

What are the clinical features of congenital hip dysplasia?

A
  • double crease and asymmetrical gluteal folds
  • extra creases as hip not in acetabulum
  • shortened thigh as femur higher in acetabulum
  • external rotation
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12
Q

How is congenital hip dysplasia diagnosed?

A
  • Barlow’s test = adduct and push downwards to try and dislocate hip
  • Ortolani’s test = abduct hip and try to relocate, push fingers towards into acetabulum
  • Galeazzi sign = flex hip and compare height of knees, will be unequal
  • radiograohy = x-rays not useful as head of femur just starting to ossify, visualise bone and tissue movement in real life
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13
Q

What is seen on a x-ray in congenital hip dysplasia?

A
  • Hilgenreiner’s Line = horizontal line from 1 acetabulum to other
  • perpendicular index line = measures angle along acetabular surface
  • Perkin’s line = perpendicular to Hilgenreiner’s line, 2/3 of femoral head should be medial to that line
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14
Q

What is the treatment of congenital hip dysplasia?

A
  • maintain reduction of femoral head in true acetabulum

- subluxation corrects spontaneously

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15
Q

What is the treatment for CHD of a newborn to 6 months?

A
  • Pavlik harness = closed reduction and immbolisation, hip flexed and abducted while still allowing movement, 6 weeks, if hip not reduced in 3 weeks need alternative
  • closed reduction
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16
Q

What is the treatment for CHD for older than 6 months?

A
  • open reduction = neck of femur and acetabulum reduced

- need to be careful of AVN and femoral nerve palsies = cannot straighten knee and get foot drop

17
Q

What happens if CHD is left untreated?

A
  • lead to false acetabulum
  • femoral head pushes into ileum posteriorly
  • OA
18
Q

What is Perthe’s disease?

A
  • self limiting AVN of femoral head
  • idiopathic
  • 4-8 years old
  • males
  • blood supply re-establishes itself as new ossification forms
19
Q

What are the 4 stages of Perthe’s?

A
  • necrosis
  • fragmentation
  • re-ossification
  • re-modelling
20
Q

What is the necrosis stage of Perthe’s?

A
  • portion of femoral head dies
  • shape changes
  • pain, stiffness, inflammation
  • up to 1 year
21
Q

What is the fragmentation stage of Perthe’s?

A
  • dead cells absorbed and replaced by new bone cells
  • femoral head shape varies
  • 1-3 years
22
Q

What is the re-ossification stage of Perthe’s?

A
  • femoral head continues grow with new bone cells

- 1-3 years

23
Q

What is the re-modelling stage of Perthe’s?

A
  • new bone cells gradually replaced by normal bone cells
  • remodelling continues
  • 1-3 years or more
24
Q

What is the treatment for Perthe’s?

A
  • <5/mild = observation, physio, bed rest
  • plaster casts/braces = abduction to keep head in acetabulum
  • > 5 = surgery, osteotomy
25
Q

What is a slipped upper femoral epiphysis?

A
  • 10-17 years
  • 13 years boys
  • 11.5 girls and less severe
  • left hip more common
  • more boys
26
Q

What are the risk factors of SUFE?

A
  • obesity
  • hypothyroidism
  • deficiency or increased androgens
  • trauma
    (obese, underdeveloped sexual characteristics)
27
Q

What is the pathophysiology of SUFE?

A
  • fracture of growth plate = slippage of epiphysis
  • head of femur remains in acetabulum
  • metaphysis moves in anterior direction with external rotation
28
Q

What are the types of slip in SUFE?

A
  • pre-slip = wide epiphyseal line no slippage
  • acute = sudden slippage
  • acute-on-chronic = slippage acutely on existing chronic slip
  • chronic = steady progressive slippage, most common
29
Q

What changes happen after a slip in SUFE?

A
  • to epiphyseal plate zones
  • hypertrophic zone becomes majority of plate
  • Klein’s line pathology
30
Q

What is Klein’s line?

A
  • in SUFE
  • draw along superior border of femoral neck and should cross at least a portion of femoral head but in SUFE head drops below line
31
Q

What is the treatment for SUFE?

A
  • rest
  • analgesia
  • surgery = closure of EGP, corrective osteotomy
  • bilateral fixation to stop further slippage
32
Q

What is Blount’s disease?

A
  • growth problem of distal tibia
  • tibia varus (medial more weight bearing)
  • EGP squashed
  • angulation
33
Q

What is the cause of Blount’s disease?

A
  • unknown
  • effects of weight on EGP
  • walking early
  • genetics
34
Q

What is the treatment of Blount’s disease?

A
  • brace

- surgical = early onset, when brace fails -> osteotomy, gradual distraction

35
Q

What is Osgood-Schlatters?

A
  • osteochondritis = disturbance of endochondral ossification
  • most common cause of knee pain in children
  • self-limiting (symptoms disappear 1 year after onset)
  • residual knee pain when kneeling
36
Q

What is the pathophysiology of Osgood-Schlatters?

A
  • repeated traction from patellar ligament on tibial tuberosity
  • avulsion fractures to parts of tibial tuberosity
37
Q

What is the treatment of Osgood-Schlatters?

A
  • rest
  • avoid activites causing pain
  • NSAIDs

LOCO2 (26 decks)

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