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LOCO2 > Bone And Joint Problems Of Childhood > Flashcards

Bone And Joint Problems Of Childhood Flashcards

1
Q

Common MSK problems of childhood

A

Flat foot
Club foot
Toe walking
CDH
Perthe’s
SUFE
blounts
Osgood schlatter

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2
Q

Why are babies born with flat feet

A

Fat pad in medial arch
Arch develops as fat pad used for growth

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3
Q

What condition is suggested by parents describing a child as having ‘weak ankles’

A

Flat foot

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4
Q

In children with flat foot does the ankle appear to turn inwards or outwards

A

Inwards

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5
Q

What causes the arch to not develop in flat foot

A

Muscle imbalance
Abnormal shaped tarsals

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6
Q

Treatment of flat foot

A

Usually doesn’t require treatment
Orthotics
Surgery

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7
Q

At what age does toe walking disappear in most children

A

2yrs

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8
Q

What conditions can lead to toe walking in children over 2

A

Cerebral palsy
Duchenne muscular dystrophy
Nervous system problems

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9
Q

Toe walking treatment

A

Casting foot and ankle - stretch calf muscles
Physiotherapy
Surgery - release tight calf muscles

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10
Q

How long is the foot and ankle kept in a cast to treat toe walking

A

~6wks

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11
Q

What is talipes equinovarus more commonly known as

A

Club foot

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12
Q

Which 2 fixed deformities make up club foot/talipes equinovarus

A

Varus
Equinus

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13
Q

Which muscles are underdeveloped in club foot

A

Calf muscles

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14
Q

Is club foot usually bilateral or unilateral

A

50:50

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15
Q

What other conditions is club foot associated with

A

Breech presentation
Connective tissue disorders
Oligohydramnios
Edwards syndrome + other genetic conditions
Family history

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16
Q

Club foot treatment

A

Poseti method - manipulative technique using a sequence of casts and braces around foot to return foot and knee to normal position

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17
Q

When does congenital hip dysplasia form

A

Present at birth

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18
Q

Congenital hip dysplasia risk factors

A

Female
Breech delivery
Family history
Oligohydramnios
1st born
Other skeletal disorders

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19
Q

What condition is suggested by a ‘double crease’ on an infants leg/hip

A

Congenital hip dysplasia

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20
Q

What is the most common outcome in untreated congenital hip dysplasia

A

Spontaneously resolves in 2-8wks

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21
Q

3 tests used to diagnose congenital hip dysplasia

A

Barlow test
Ortolani test
Galeazzi sign

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22
Q

Barlow test

A

Adducting the hip and pushing down while palpating for the head falling out the back of the acetabulum

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23
Q

Ortolani test

A

Hip abducted to try and relocate hip, hip popping back into acetabulum felt

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24
Q

Galeazzi sign

A

Knees not level when infant lying down with knees fully flexed

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25
Q

why is ultrasound more useful for assessing congenital hip dysplasia than x ray

A

Femoral head not ossified until 4-6months

26
Q

What angle is used to grade congenital hip dysplasia

A

Alpha angle

27
Q

Alpha angle

A

Angle between line of iliac margin and line of joint inclination

28
Q

Normal alpha angle

A

> 60*

29
Q

What alpha angles show grade I, grade IIa/b, grade IIc, and grade III/IV congenital hip dysplasia

A

I - >60* - normal
IIa/b - 50-59*
IIc - 43-49*
IIIa/b / IV - <43

30
Q

What line goes between the inferior aspects of both triradate cartilages of the acetabulums, through the epiphyseal growth plates

A

Hilgenreiner line

31
Q

Perkins line

A

line drawn perpendicular to Hilgenreiner line, intersecting the lateral most aspect of the acetabular roof

32
Q

What does the acetabular index line measure

A

Acetabular inclination

33
Q

What 3 lines are used in radio graphical assessment of congenital hip dysplasia

A

Hilgenreiners line - horizontal
Perkins line - vertical
Acetabular index line - diagonal

34
Q

Congenital hip dysplasia treatment

A

Pavlik harness - closed reduction and immobilisation
Closed reduction with Hip spica - Pavlik not working or child 6months+
Open reduction - femoral Osteotomy - child 18mo+

35
Q

Why does a Pavlik harness hold the hip flexed and abducted, and how long is it worn for

A

Deepest insertion of femoral head into acetabulum
At least 6wks full time then 6 weeks part time

36
Q

How long is a hip spica used for closed reduction on congenital hip dysplasia

A

12 weeks

37
Q

What does untreated congenital hip dysplasia lead to

A

Leg length discrepency

38
Q

Perthes disease

A

Self limiting avascular necrosis of the femoral head

39
Q

What age and gender does perthes disease usually affect

A

4-8yrs
Male

40
Q

What causes perthes disease

A

Blood vessels to femoral head shut down

41
Q

Why does perthes disease cause widening of the femoral neck

A

Femoral neck gets all blood supply for head of femur

42
Q

4 stages of perthes disease

A

Necrosis - portion of femoral head dies
Fragmentation - dead bone cells absorbed and replaced producing varied femoral head shapes
Reossification - new bone cells
Remodelling - new bone cells replaced by normal bone cells

43
Q

Which stage of perthes disease causes pain, stiffness, and inflammation

A

Necrosis

44
Q

Perthes disease treatment

A

Under 5/mild - observation, physio, bed rest, cast/brace abduction
Older - Osteotomy surgery

45
Q

What does SUFE stand for

A

Slipped upper femoral epiphysis

46
Q

How does SUFE age of onset and severity vary between sexes

A

Boys - more common + 13yrs + less severe + lasts 4.5 months
Girls - 11.5yrs + more severe + lasts 3.6 months

47
Q

SUFE age range

A

10-17 yrs

48
Q

Which part of the femur moves in SUFE

A

Neck and shaft of femur

49
Q

How does the epiphysis move in relation to the femur in SUFE

A

posteriorly and medially
Appears like head is falling off neck+shaft

50
Q

What leads to SUFE

A

Salter Harris type 1 fracture
Obesity
Hypothyroidism
Decr/incr androgens -> adolescent growth spurt
Trauma

51
Q

4 types of 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

52
Q

SUFE treatment

A

Rest
Analgesia
Surgical closure of epiphyseal growth plate
Corrective Osteotomy

53
Q

Blount’s disease

A

Growth disorder of the proximal tibia causing tibia Varus (bowed tibia) and knees bowing outwards

54
Q

What is thought to cause blounts disease

A

Effect of weight on epiphyseal growth plate and medial part of proximal tibia develops abnormally

55
Q

Age ranges of infantile juvenile and adolescent blounts disease

A

I 1-3yrs
J 4-10yrs
A 10+yrs

56
Q

Blounts disease risk factors

A

Obesity
Walking early
Genetic factors

57
Q

Blounts disease treatment

A

Brace
Osteotomy
Gradual distraction

58
Q

Osgood schlatters disease

A

Self limiting Overuse syndrome causing Osteochondrosis of tibial tubercle in young athletic population

59
Q

How long does Osgood schlatters disease last

A

~1yr

60
Q

Most common causes of Osgood schlatters

A

Repeated traction from patellar ligament on tibial tuberosity
Avulsion fracture to part of tibial tuberosity

61
Q

Osgood schlatters signs and symptoms

A

Pain tenderness and swelling at point of insertion of patellar ligament

62
Q

Osgood schlatter treatment

A

Rest
Avoidance of activities that cause pain
NSAIDs
Strapping and bracing to support knee

LOCO2 (26 decks)

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