Children's Orthopaedics

Question 1

What is meant by skeletal dysplasia?

Answer 1

Medical term for little person

Question 2

What is the most common type of skeletal dysplasia?

Answer 2

Achondroplasia

Question 3

Which classification system is used to scale the degree of joint hypermobility of a patient?

Answer 3

Wynne-Davies Classification

- common with skeletal dysplasias

Question 4

What is Duchenne Muscular Dystrophy?

Answer 4

X linked recessive

Progressive muscular weakness noticed when boy starts to stand

Question 5

What is the lifespan of a boy with DMD?

Answer 5

~ 20 years

Question 6

How is DMD diagnosed?

Answer 6

Raised serum creatine phosphokinase

Abnormal muscle biopsy

Question 7

What is cerebral palsy (CP)?

Answer 7

Neuromuscular disorder appearing before 3yo

Caused by insult to immature brain before, during or after birth

Question 8

List 5 causes of CP

Answer 8

Genes
Intrauterine infection
Prematurity
Intra-cranial haemorrhage
Hypoxia during birth

Question 9

How does CP lead to bone deformity?

5 steps

Answer 9

Brain injury
Increased muscle tone
Abnormal posture
Muscle contracture
Bone deformities

Question 10

List the 3 features of Lower Motor Neurone inhibition

Answer 10

Spasticity
Hyperreflexia clonus
Co-contraction

Question 11

Define spasticity

Answer 11

Condition with abnormally increased muscle tone, affects movement and speech

Question 12

List 4 features of loss of LMN connection

Answer 12

Weakness
Fatigability
Poor balance
Sensory deficits

Question 13

List 3 treatments for CP

Answer 13

Benzodiazapines (acutely)
Botox injections
Dorsal rhizotomy

Question 14

What is tiptoe walking?

Answer 14

Child walking on balls of feet

Question 15

Up to what age is tiptoe walking regarded as normal?

Answer 15

3 years

Question 16

What are cavus feet?

Answer 16

When a person stands and there is a larger than normal gap between the midfoot and ground

Question 17

How do cavus feet normally look?

Answer 17

Heel and toes slightly inverted

“claw”/curled toes

Question 18

What is frontal bossing?

Answer 18

Prominent forehead

- associated with achondroplasia

Question 19

What is Developmental Dysplasia of the Hip (DDH)?

Answer 19

Dislocation/subluxation of the femoral head
During perinatal period
Affects subsequent development of hip joint

Question 20

Which sex is more affected by DDH?

Answer 20

Females

Question 21

List 5 risk factors associated with the development of DDH

Answer 21

Family history
Breech position
First borns
Down's syndrome
Talipes etc

Question 22

List 3 clinical signs of DDH

Answer 22

Lower limb shortening
Asymmetric groin
Thick skin creases ^

Question 23

Which 2 maneouvres are used to check for the presence of DDH

Answer 23

Ortolani test

Barlow test

Question 24

After what age can Xrays be used to detect DDH?

Answer 24

4-6 months

- before this, the femoral head is not ossified

Question 25

How may the body compensate for untreated/severe DDH?

Answer 25

Develops false acetabulum anterior to the physiological one | - results in shorter limb and severe arthritis

Question 26

What is osteochondrosis?

Answer 26

Aseptic ischaemic necrosis | Primarily in centre of ossification on epiphysis

Question 27

What is Perthes disease?

Answer 27

Idiopathic osteochondritis of the femoral head

Question 28

Which age group and sex is most commonly affected by Perthes?

Answer 28

(active + short) Boys | 4-9

Question 29

What is Slipped Upper Femoral Epiphysis (SUFE)?

Answer 29

``` Femoral physis (growth plate) too weak to support body weight Epiphysis slips under the strain 1/3 cases bilat. ```

Question 30

What age group and sex are normally affected by SUFE?

Answer 30

Overweight | Pre-pubescent boys

Question 31

Which 2 conditions may predispose a child to developing SUFE?

Answer 31

Hypothyroidism | Renal disease

Question 32

What is a strange but common presentation of SUFE?

Answer 32

ONLY knee pain | also, loss of internal rotation of hip

Question 33

What is the surgical treatment of SUFE?

Answer 33

Pinning of the femoral head