Children’s Orthopaedics - Complex needs - CP, Talipes,Scoliosis

Question 1

Which functions may be involved in complex exceptional needs?

Answer 1

Learning and mental functions 
Communication 
Motor skills 
Self care 
Hearing 
Vision 

Child has CEN if 4 involved or 4 involved and on ventilation
or impairments for over 6 months

Question 2

What is cerebral palsy?

Answer 2

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

Question 3

What are the main causes in prenatal CP?

Answer 3

Placental insufficiency
Toxaemia
Smoking
Alcohol
Drugs
Infection
Rubella
CMV
Herpes

Question 4

What are the main causes in perinatal CP?

Answer 4

Prematurity
Anoxic injury
Infection
Kernicterus
Haemolytic disease of the newborn

Question 5

What are the main causes of postnatal CP?

Answer 5

CMV
Rubella
Head trauma

Question 6

Where does Spastic CP affect?

Answer 6

Pyramidal system

Motor cortex

Question 7

Where does athetoid system affect?

Answer 7

Extrapyramidal system

Basal ganglia

Question 8

Where does Ataxia CP affect?

Answer 8

Cerebellum and brainstem

Question 9

What is GMFCS?

Answer 9

Gross Motor Function Classification System
LEVEL I - Walks without Limitations
LEVEL II - Walks with Limitations
LEVEL III - Walks Using a Hand-Held Mobility Device
LEVEL IV - Self-Mobility with Limitations
LEVEL V - Transported in a Manual Wheelchair

Question 10

What are the main issues in CP?

Answer 10

Spasticity
Lack of voluntary limb control
Weakness
Poor co-ordination
Impaired senses (Hearing, Vision, Taste, Touch etc)

Question 11

What are dynamic contractures? (CP)

Answer 11

Increased muscle tone and hyper-reflexia
No fixed deformity of joints
Deformity can be overcome

Question 12

What are fixed muscle contractures?

Answer 12

Persistent spasticity and contracture
Shortened muscle tendon units
Deformity cannot be overcome

Question 13

How might joint subluxation/dislocation occur in CP?

Answer 13

Secondary bone changes

Joint degeneration

Question 14

How is the gait lab used?

Answer 14

Document joint movement
Force distribution through feet
Timing of cycle

Question 15

How do we estimate risk of hip dislocation in CP?

Answer 15

GMCFS

Question 16

How can we manage posture in CP?

Answer 16

Physiotherapy

Seating

Question 17

What are some treatment options for generalised spasticity?

Answer 17

Baclofen oral

Diazepam

Question 18

What are some treatment options for localised spasticity?

Answer 18

Botulinum toxin

Baclofen intra-thecal pump

Question 19

How is deformity treated in CP?

Answer 19

Soft tissue release for adductors and hamstrings

Varus derotation osteotomy or pelvic osteotomy for bony realignment

Question 20

What are some pros for surgical options in CP?

Answer 20

Reduced risk dislocation
Reduced risk pain
Better seating

Question 21

What are some drawbacks of surgical CP treatment?

Answer 21

Not all would have gone on to dislocate

It is a very big surgery

Question 22

What is another name for club feet?

Answer 22

Congenital talipes equinovarus

Question 23

How can clubfoot be diagnosed?

Answer 23

60% identified by USS

Question 24

What are some treatment options for clubfeet?

Answer 24

Strapping
Serial casting
Dennis Browne Boots
Surgery
Postero-medial release
Ilizarov frame

Question 25

How can we remember anatomy of clubfoot?

Answer 25

CAVE acronym Cavus Adductus (midfoot) Varus (hindfoot) Equinus (hindfoot)

Question 26

How is equinus corrected surgically?

Answer 26

Percutaneous tenotomy of achilles tendon

Question 27

What is non-structural scoliosis?

Answer 27

Due to extrinsic cause like a leg length discrepancy, a hip problem etc. Resolves when causal factor is addressed

Question 28

What is structural scoliosis?

Answer 28

Abnormal rotation of the vertebrae Intrinsic spinal problem It has a propensity to progress

Question 29

How do we highlight scoliosis on examination

Answer 29

Structural scoliosis worse on torso flexion | Abnormal neurology or pain should be noted

Question 30

What is MRI used for in scoliosis?

Answer 30

Cord abnormalities Vertebral anomalies in formation/segmentation Tumours

Question 31

What are some consequences of severe curves in scoliosis?

Answer 31

Cardiorespiratory compromise Pain from rib/pelvic abutment Seating issues Surgical challenge

Question 32

What are the non-surgical options for managing scoliosis?

Answer 32

Bracing Needs to be worn 23/24 hours to work Usually used to delay surgery while spine is growing

Question 33

What are some possible surgical complications in scoliosis?

Answer 33

``` Nerve root damage Cord traction injury Vascular injury Degenerative changes later Problems of growth like growing rods, changing rods, crankshaft phenomenon ```

Question 34

What is crankshaft phenomenon?

Answer 34

Progressive rotational and angular spinal deformity that can occur after posterior spinal surgery

Question 35

What are some "manufacturing defects" causing infant abnormalities?

Answer 35

``` Spina Bifida Proximal femoral focal deficiency TAR Syndrome Thalidomide Congenital scoliosis ```

Question 36

What are some "packaging defects" causing infant abnormalities?

Answer 36

Metatarsus Adductus Infantile postural scoliosis Plagiocephaly Congenital Torticolis