Flashcards in Children's Orthopaedics Deck (42):
Which kind of growth occurs in long bones?
Which kind of growth increases the diameter of long bones?
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.
By what age should babies normally be walking?
When is genu varum normal and abnormal?
Abnormal: unilateral, severe, short stature or painful
When is genu valgum normal and abnormal?
Usually normal (peak around 3.5y)
Abnormal: Painful, asymmetric or severe
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
What are some of the possible causes of intoeing?
Femoral neck anteversion (increases internal rotation of hip), Internal Tibial Torsion,
metatarsus adductus or combination
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
What are the 2 types of flat feet?
Flexible or fixed (rigid). Rigid is much more serious
What are the possible causes of flexible flat feet?
Generalised ligamentous laxity (hypermobility) or tightness gastrocsoleus complex
What are the possible causes of fixed flat feet?
Which score is used to measure hpermobility?
Beughtin score (out of 9)
What must you check in anterior knee pain?
A deformity in which the foot is twisted out of normal position
What causes positional talipes?
What is the difference between physiological and pathological talipes?
Physiological is correctible
What is the difference between equinus and calcaneus talipes?
Equines is plantar-flexed, while calcaneus is dorsiflexed
What is Congenital Talipes Equinovarus more commonly known as?
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)
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
What are the 3 subtypes of causes of tip toe gait?
2) Structural (tight achilles)
3) Neurological eg. spasticity, spina bifida, cerebral palsy etc
a group of non progressive disorders in which disease of the brain causes an impairment of motor function.
a condition where the spine does not develop properly, leaving a gap in the spine.
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)
What are the topographical classifications of cerebral palsy?
Hemiplegia (unilateral0 walkers), diplegia (bilateral- standers) or totally body involvement (sitters)
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
Which score is used in cerebral palsy?
Gross motor function score
What are the main risk factors for DDH?
Breech position and family history
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)
True or False: instability tests can be used for the first year of life
False, they are unreliable after 6 weeks
What is the investigation of choice for DDH in >3 months and < 3months?
<3 months = US
3-6 months = x-ray (calcified epiphysis)
What is the treatment of DDH with early diagnosis?
What is the treatment of DDH with late diagnosis?
Closed or open reduction followed by hip spica
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
Who is more likely to get Perthes, boys or girls?
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).
True or False: An adolescent with hip/groin thigh or knee pain has a SUFE until proven otherwise
Which type of x-ray is imperative in SUFE?