Bone And Joint Problems Of Childhood

Question 1

Common MSK problems of childhood

Answer 1

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

Question 2

Why are babies born with flat feet

Answer 2

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

Question 3

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

Answer 3

Flat foot

Question 4

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

Answer 4

Inwards

Question 5

What causes the arch to not develop in flat foot

Answer 5

Muscle imbalance
Abnormal shaped tarsals

Question 6

Treatment of flat foot

Answer 6

Usually doesn’t require treatment
Orthotics
Surgery

Question 7

At what age does toe walking disappear in most children

Answer 7

2yrs

Question 8

What conditions can lead to toe walking in children over 2

Answer 8

Cerebral palsy
Duchenne muscular dystrophy
Nervous system problems

Question 9

Toe walking treatment

Answer 9

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

Question 10

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

Answer 10

~6wks

Question 11

What is talipes equinovarus more commonly known as

Answer 11

Club foot

Question 12

Which 2 fixed deformities make up club foot/talipes equinovarus

Answer 12

Varus
Equinus

Question 13

Which muscles are underdeveloped in club foot

Answer 13

Calf muscles

Question 14

Is club foot usually bilateral or unilateral

Answer 14

50:50

Question 15

What other conditions is club foot associated with

Answer 15

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

Question 16

Club foot treatment

Answer 16

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

Question 17

When does congenital hip dysplasia form

Answer 17

Present at birth

Question 18

Congenital hip dysplasia risk factors

Answer 18

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

Question 19

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

Answer 19

Congenital hip dysplasia

Question 20

What is the most common outcome in untreated congenital hip dysplasia

Answer 20

Spontaneously resolves in 2-8wks

Question 21

3 tests used to diagnose congenital hip dysplasia

Answer 21

Barlow test
Ortolani test
Galeazzi sign

Question 22

Barlow test

Answer 22

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

Question 23

Ortolani test

Answer 23

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

Question 24

Galeazzi sign

Answer 24

Knees not level when infant lying down with knees fully flexed

Question 25

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

Answer 25

Femoral head not ossified until 4-6months

Question 26

What angle is used to grade congenital hip dysplasia

Answer 26

Alpha angle

Question 27

Alpha angle

Answer 27

Angle between line of iliac margin and line of joint inclination

Question 28

Normal alpha angle

Answer 28

>60*

Question 29

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

Answer 29

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

Question 30

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

Answer 30

Hilgenreiner line

Question 31

Perkins line

Answer 31

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

Question 32

What does the acetabular index line measure

Answer 32

Acetabular inclination

Question 33

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

Answer 33

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

Question 34

Congenital hip dysplasia treatment

Answer 34

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

Question 35

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

Answer 35

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

Question 36

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

Answer 36

12 weeks

Question 37

What does untreated congenital hip dysplasia lead to

Answer 37

Leg length discrepency

Question 38

Perthes disease

Answer 38

Self limiting avascular necrosis of the femoral head

Question 39

What age and gender does perthes disease usually affect

Answer 39

4-8yrs Male

Question 40

What causes perthes disease

Answer 40

Blood vessels to femoral head shut down

Question 41

Why does perthes disease cause widening of the femoral neck

Answer 41

Femoral neck gets all blood supply for head of femur

Question 42

4 stages of perthes disease

Answer 42

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

Question 43

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

Answer 43

Necrosis

Question 44

Perthes disease treatment

Answer 44

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

Question 45

What does SUFE stand for

Answer 45

Slipped upper femoral epiphysis

Question 46

How does SUFE age of onset and severity vary between sexes

Answer 46

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

Question 47

SUFE age range

Answer 47

10-17 yrs

Question 48

Which part of the femur moves in SUFE

Answer 48

Neck and shaft of femur

Question 49

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

Answer 49

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

Question 50

What leads to SUFE

Answer 50

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

Question 51

4 types of SUFE

Answer 51

pre slip - wide epiphyseal line no slippage Acute - sudden slippage Acute on chronic - slippage acutely on existing chronic slip Chronic - steady progressive slippage

Question 52

SUFE treatment

Answer 52

Rest Analgesia Surgical closure of epiphyseal growth plate Corrective Osteotomy

Question 53

Blount’s disease

Answer 53

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

Question 54

What is thought to cause blounts disease

Answer 54

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

Question 55

Age ranges of infantile juvenile and adolescent blounts disease

Answer 55

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

Question 56

Blounts disease risk factors

Answer 56

Obesity Walking early Genetic factors

Question 57

Blounts disease treatment

Answer 57

Brace Osteotomy Gradual distraction

Question 58

Osgood schlatters disease

Answer 58

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

Question 59

How long does Osgood schlatters disease last

Answer 59

~1yr

Question 60

Most common causes of Osgood schlatters

Answer 60

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

Question 61

Osgood schlatters signs and symptoms

Answer 61

Pain tenderness and swelling at point of insertion of patellar ligament

Question 62

Osgood schlatter treatment

Answer 62

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