Children's Orthopaedics Flashcards Preview

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Flashcards in Children's Orthopaedics Deck (42):
1

Which kind of growth occurs in long bones?

Endochondral ossification

2

Which kind of growth increases the diameter of long bones?

Appositional growth

3

In a basic description, how does endochondral ossification occur?

Occurs at the epiphyseal plate, where there a multiple layers. Chondrocytes multiply in one layer, then the eventually die in lower layers as the surrounding matrix is calcified, when they then are ossified at the diaphyses.

4

By what age should babies normally be walking?

14-17 months

5

Genu varum

bow legged

6

Genu valgum

knock kneed

7

When is genu varum normal and abnormal?

Normal: <2y
Abnormal: unilateral, severe, short stature or painful

8

When is genu valgum normal and abnormal?

Usually normal (peak around 3.5y)
Abnormal: Painful, asymmetric or severe

9

What is Blounts Disease, typical appearance and treatment?

Growth arrest of medial tibial physis of unknown aetiology (?weight overload).
Typical Beak-like protrusion on x-ray.
Hemiepihysiodesis is the surgical treatment

10

What are some of the possible causes of intoeing?

Femoral neck anteversion (increases internal rotation of hip), Internal Tibial Torsion,
metatarsus adductus or combination

11

Why are we all born with flat feet but normally don't have it in adulthood?

We develop a medial arch once walking when tibialis posterior strengthens

12

What are the 2 types of flat feet?

Flexible or fixed (rigid). Rigid is much more serious

13

What are the possible causes of flexible flat feet?

Generalised ligamentous laxity (hypermobility) or tightness gastrocsoleus complex

14

What are the possible causes of fixed flat feet?

Tarsal coalition

15

Which score is used to measure hpermobility?

Beughtin score (out of 9)

16

What must you check in anterior knee pain?

Hips

17

Talipes

A deformity in which the foot is twisted out of normal position

18

What causes positional talipes?

Intrauterine position

19

What is the difference between physiological and pathological talipes?

Physiological is correctible

20

What is the difference between equinus and calcaneus talipes?

Equines is plantar-flexed, while calcaneus is dorsiflexed

21

What is Congenital Talipes Equinovarus more commonly known as?

Club foot

22

What are the 3 main types of spina bifida?

1) Occulta (spine is still closed)
2) Meningocele (meninges have pushed out of spine)
3) Myelomeningocoele (meninges and spinal cord has pushed out of spine)

23

What are the 5 main causes of limp?

1) Antalgic (pain in the limb so minimise stance phase)
2) Trendelenberg (pelvis tilts so need to tilt body for foot clearance)
3) Short leg
4) Tip toe
5) Neurologic

24

What are the 3 subtypes of causes of tip toe gait?

1) Habitual
2) Structural (tight achilles)
3) Neurological eg. spasticity, spina bifida, cerebral palsy etc

25

Cerebral Palsy

a group of non progressive disorders in which disease of the brain causes an impairment of motor function.

26

Spina Bifida

a condition where the spine does not develop properly, leaving a gap in the spine.

27

What causes cerebral palsy?

Neurological problems that can either occur prenatal (prematurity), perinatal (birth trauma e.g., asphyxia) or postnatal (eg. infection or cereal haemorrhage)

28

What are the topographical classifications of cerebral palsy?

Hemiplegia (unilateral0 walkers), diplegia (bilateral- standers) or totally body involvement (sitters)

29

What is the management of cerebral palsy?

Can either use drugs/surgery acting at the dorsal horn or surges such as hamstring/gastroc lengthening to optimise walking/sitting

30

Which score is used in cerebral palsy?

Gross motor function score

31

What are the main risk factors for DDH?

Breech position and family history

32

What are the 3 instability tests to screen for DDH?

Barlow (sublux the hip), Ortolani (relocate the hip) and Galeazzi (lie the baby feet to bum and if knees aren't level it is +ve)

33

True or False: instability tests can be used for the first year of life

False, they are unreliable after 6 weeks

34

What is the investigation of choice for DDH in >3 months and < 3months?

<3 months = US
3-6 months = x-ray (calcified epiphysis)

35

What is the treatment of DDH with early diagnosis?

Pavlov harness

36

What is the treatment of DDH with late diagnosis?

Closed or open reduction followed by hip spica

37

What is Perthes?

Idiopathic avascular necrosis in children, where the blood supply to the epiphysis becomes inadequate. As a result the bone softens and breaks down

38

Who is more likely to get Perthes, boys or girls?

Boys (4:1)

39

What is SUFE?

Slipped Upper Femoral Epiphysis - A fracture through the growth plate, which results in slippage of the overlying end of the femur (epiphysis).

40

True or False: An adolescent with hip/groin thigh or knee pain has a SUFE until proven otherwise

True

41

Which type of x-ray is imperative in SUFE?

Lateral view

42

What are you thinking of in 1) Newborn 2) pre-school and 3) adolescent with hip problems?

1) DDH
2) Perthes
3) SUFE