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Year 2- MSK > Children's Orthopaedics - Complex needs > Flashcards

Children's Orthopaedics - Complex needs Flashcards

1
Q

What is meant by complex needs in a child?

A

A child with multiple and complex disabilities and at least two different types of severe impairment in which nobody has the knowledge of treatment

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2
Q

List some of the complex needs of a child in which orthopaedic involvement is required.

A

Cerebral palsy
Spina bifida
Muscular dystrophy
Arthrogryposis
Neurofibroblastomas
Syndromes e.g. Downs, Turners

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3
Q

Define cerebral palsy.

A

A permanent and non-progressive motor disorder due to brain damage before birth or during the first 2yrs of life

->the lesion is static but symptoms of the child and the clinical picture differ as the child develops

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4
Q

What are some of the prenatal causes of cerebral palsy?

A

Smoking
Placental insufficiency
Toxaemia
Alcohol
Drugs
Rubella infection
Toxoplasmosis infection
CMV
Herpes type II

->TORCH (toxoplasmosis, rubella, CMV and herpes)

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5
Q

What are some of the perinatal causes of cerebral palsy?

A

Prematurity (most common)
Anoxic injuries
Infection
Haemolytic disease of newborn

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6
Q

What are some of the postnatal causes of cerebral palsy?

A

Infection e.g. CMV, rubella
Head trauma

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7
Q

There are different classifications of cerebral palsy; physiologic, anatomical and GMF (gross motor function).

What are the three types of physiologic classifications of cerebral palsy?

A

Spastic
Athetoid
Ataxia

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8
Q

Where does spastic physiologic CP affect?

A

Pyramidal system and motor cortex

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9
Q

Where does athetoid physiologic CP affect?

A

Extrapyramidal system and basal ganglia

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10
Q

Where does ataxia physiologic CP affect?

A

Cerebellum and brainstem

->problems with balance, think of where it’s affecting

->in many there’s a combo of these different types

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11
Q

What is the most common type of physiological classification of cerebral palsy?

A

Spastic CP

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12
Q

There are different classifications of cerebral palsy; physiologic, anatomical and GMF (gross motor function).

What are the four types of anatomical classifications of cerebral palsy?

A

Monoplegia
Hemiplegia
Diplegia
Quadriplegia

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13
Q

Monoplegia?

A

One limb involved in CP

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14
Q

Hemiplegia?

A

One side of body affected by CP

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15
Q

Diplegia?

A

Lower limbs affected by CP

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16
Q

Quadriplegia?

A

Total body involvement of CP

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17
Q

There are different classifications of cerebral palsy; physiologic, anatomical and GMF (gross motor function).

The GMF classification has different levels. Briefly run through them so you are aware of them.

A

Level 1= walks w/o limitation
Level 2= walks w/ limitations
Level 3= walks using hand-held mobility device
Level 4= self-mobility w/ limitations, may use powered mobility
Level 5= transported in a manual wheelchair

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18
Q

What are the issues seen in a patient with cerebral palsy?

A

Spasticity (increased muscle tone)
Lack of voluntary limb control
Weakness
Poor coordination
Impaired senses- hearing, vision, taste, touch

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19
Q

As a result of the spasticity, different types of problems can occur in the limbs.

What is meant by dynamic contracture?

A

A limb adopts a posture due to increased tone and hyper-reflexia.
However, on passive stretching, there’s no fixed deformity in the joints

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20
Q

What can a dynamic contracture progress to?

A

A fixed contracture- persistence of spasticity and stiffness means muscle tendon unit shortens.
This cannot be overcome.

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21
Q

In extreme cases, a patient with cerebral palsy may develop joint sublucation/dislocation. What is meant by this?

A

Secondary bony changes in the joint which then leads to arthritis

22
Q

Gait is assessed in CP patients. What are the two phases of the gait cycle?

A

Stance (weight being put through limb)
Swing

23
Q

What are some of the hip conditions associated with cerebral palsy?

A

Hip displacement (occurs in a third of children w CP)

->these dislocations are painful and upset sitting posture

24
Q

All CP patients have normal hips ay birth.

If a child with CP does develop issues with hip displacement, what helps to improve the long term outcome?

A

Early surgical intervention

25
Q

If suspicious of a child at risk of hip displacement, what cam be done?

A

Posture management- physio and specialised seating
Spasticity management- med based- oral and injections

26
Q

Which kind of surgical procedures can be used in the management of deformity in patients with CP which are more likely to develop hip displacements?

A

Soft tissue release
Bony realignment

27
Q

What is the most common congenital deformity seen in orthapaedics?

A

Club foot (talipes)

28
Q

Who tends to be more affected by club foot?

A

M>F

29
Q

Is club foot bilateral?

A

50% of the time

30
Q

Aetiology behind club foot?

A

Multifactorial and not clear- genetic component though

31
Q

When can club foot be diagnosed?

A

During prenatal period using prenatal ultrasound- 60% of cases diagnosed at this point

32
Q

Talipes, or club foot, can also be an indication of what?

A

Defects in other symptoms- 50%

33
Q

Management of talipes/club foot?

A

Serial casting

->very few require surgery now

34
Q

Normal curvatures of the spine?

A

Cervical and Lumbar lordosis
Thoracic and Sacral kyphosis

35
Q

Scoliosis?

A

Any deviation in the coronal plane

36
Q

More than what degree of deviation is abnormal?

A

More than 10 degrees of deviation

->less than this considered normal

37
Q

Scoliosis can be structural or non-structural.
What is meant by non-structural scoliosis?

A

Due to extrinsic cause e.g. hip problem etc.
Problem is resolved when causal factor is addressed

38
Q

Scoliosis can be structural or non-structural.
What is meant by structural scoliosis?

A

Abnormal rotation of the vertebrae- an intrinsic spine problems.
Has a propensity to progress

39
Q

What are some of the factors which indicate a high risk of progression of the scoliosis?

A

< 12yrs at presentation
Size of curve at presentation
Premenarchal (before first period occurs)

40
Q

Classification of structural scoliosis is based on aetiology.
What are the classifications?

A

Congenital
Idiopathic
Neuromuscular
Others e.g. trauma, infective, degenerative (these are rarer and tend to occur more in adults)

41
Q

What is the most common type of scoliosis seen?

A

Idiopathic scoliosis

42
Q

Idiopathic scoliosis is classified by the age at presentation.
What are the three groups and the associated ages?

A

Infantile- <3yrs
Juvenile 3-10yrs
Adolescent >10yrs

43
Q

Upon examination of a child with scoliosis, in which movement will a structural scoliosis look worse?

A

When back bent over in flexion

->abnormal neurology or pain should be noted in examination as scoliosis does NOT usually cause pain

44
Q

Investigations for scoliosis?

A

Erect whole spine x-ray
MRI for cord abnormalities, tumours or vertebral anomalies (this often determines the cause of the scoliosis)

45
Q

Outcomes of scoliosis are less favourable the more severe the curvature.
What are some of the problems associated with more severe curves?

A

Cardiorespiratory compromise
Pain from ribs/pelvic abutment
Seating issues

46
Q

Non-surgical management in used particularly in the idiopathic scoliosis patients. What may be done?

A

Bracing- halts or minimises progression

47
Q

In which group of people is idiopathic scoliosis more common?

A

Teenage girls

->idk think of jokes of scoliosis made at school

48
Q

Surgery can be done…what are pros and cons?

A

Very complex and extensive but very rewarding

49
Q

Surgical complications of scoliosis surgery?

A

Nerve root damage
Cord traction injury
Vascular injury
Degenerative problems in the future
Problems of growth

50
Q
A

Year 2- MSK (36 decks)

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