hip, spine, foot (paeds)

Question 1

what is in-toeing, what is it also known as

Answer 1

feet pointing towards the midline

aka pigeon toeing

Question 2

what causes in-toeing

Answer 2

(in order of frequency)

metatarsal adductus
internal tibial torsion
femoral neck anteversion
a combo of the above

Question 3

what is genu valgum

Answer 3

knock-knees

Question 4

when does genu valgum peak?

Answer 4

3 1/2yrs

Question 5

when would you suspect genu valgum is abnormal

Answer 5

unilateral/asymmetric
painful
severe
if intermalleolar distance >8cm by 11yrs

Question 6

what are the pathological causes of genu valgum

Answer 6

tumours
rickets
neurofibromatosis

Question 7

what is genu varum

Answer 7

bowed legs

Question 8

at what age is genu varum normal

Answer 8

<2yrs

Question 9

when would you suspect genu varum is abnormal

Answer 9

unilateral/asymmetrical
severe
short stature
painful

Question 10

what are the pathological causes of genu varum

Answer 10

skeletal dysplasia
rickets
tumor
Blout’s disease

Question 11

what is Blout’s disease

Answer 11

growth arrest of medial tibial of physics, aetiology unknown

Question 12

what is the buzzword for Blout’s disease

Answer 12

beak-like protrusion

Question 13

what is spondylolisthesis

Answer 13

slippage of one vertebra over another

Question 14

at what spinal level does spondylolisthesis usually occur

Answer 14

L4/5

L5/S1

Question 15

what are the causes of spondylolisthesis

Answer 15

developmental defect

recurrent stress fracture of posterior elements which fail to heal

Question 16

what are the symptoms of spondylolisthesis? when do they present

Answer 16

present in adolescence

lower back pain
nerve pinching is slippage is severe
flat back = due t muscle spasm
waddling gait

Question 17

what is the treatment of spondylolisthesis

Answer 17

minor = rest + physio

more severe = stabilisation +/- reduction

Question 18

what is scoliosis

Answer 18

lateral curvature of the spine

Question 19

what are the causes of scoliosis

Answer 19

idiopathic (most common)
secondary to neuromuscular disease
tumour
skeletal dysplasia
infection

Question 20

investigations of scoliosis

Answer 20

X-ray

MRI but only if painful

Question 21

treatment of scoliosis

Answer 21

mild/ non-progressive = nothing

large curve/progressive = surgery

Question 22

what is Hallux valgus

Answer 22

a bunion

Question 23

when/where does Hallux valgus occur

Answer 23

late in adolescence

on the foot

Question 24

what is tarsal coalition

Answer 24

abnormal bridge (bony, fibrous, or cartilaginous) between the calcareous and navicular or between the talus and calcaneus leading to a fixed, flat foot deformity

Question 25

what is talipes equinovarus

Answer 25

club foor

Question 26

what are the risk factors of talipes equinovarus

Answer 26

``` make FM breech presentation low amniotic fluid content skeletal dysplasia ```

Question 27

symptoms of talipes equinovarus

Answer 27

50% are bilateral ankle equines (plantar flexion) supination of foot varus alignment of forefoot

Question 28

treatment of talipes equinovarus

Answer 28

early splintage = Ponseti technique | late presentation = surgery

Question 29

what is development dysplasia of the hip (DDH)

Answer 29

dislocation or subluxation of the femoral head during the perinatal period

Question 30

what hip is more commonly affected in development dysplasia of the hip (DDH)

Answer 30

Left

Question 31

what are the risk factors of development dysplasia of the hip (DDH)

Answer 31

``` female FH first born breech presentation down's syndrome lack of uterine fluid other congenital disorders ```

Question 32

symptoms of development dysplasia of the hip (DDH)

Answer 32

``` shortening, asymmetric groin/thigh creases uneven leg lengths clicl/clunk in manoeuvres positive ortolani manoeuvre posotove Barlow manoeuvre ```

Question 33

what is the Barlow manoeuvre

Answer 33

hip dislocated with flexion and posterior displacement | B for putting it Back/ posterior

Question 34

what is the ortolani manoeuvre

Answer 34

dislocated hip can be reduced with abduction and anterior displacement

Question 35

what are the investigations of development dysplasia of the hip (DDH)

Answer 35

<6 months = ultrasound | >6months = X-ray

Question 36

what is the treatment of development dysplasia of the hip (DDH)

Answer 36

pavilik harness for 23hrs daily for 6 weeks = maintains correct position serial Ultrasound to document improvement persistent dislocation >18motnhs = open or closed reduction + spica cast if reducible = reduce then monitor

Question 37

what is transient synovitis of the hip

Answer 37

self-limiting inflammation of the hip joint

Question 38

what usually precedes transient synovitis of the hip

Answer 38

URT infection

Question 39

who does transient synovitis of the hip most commonly affect

Answer 39

girls, 2-10yrs

Question 40

what are the symptoms of transient synovitis of the hip

Answer 40

limp reluctance to bear weight restricted range of motion low grade fever but NOT systemically unwell

Question 41

what are the investigations of transient synovitis of the hip, what are their purpose

Answer 41

X-ray = exclude earths CRP = exclude septic arthritis aspirate hip MRI = exclude osteomyelitis

Question 42

what is the treatment of transient synovitis of the hip

Answer 42

shot course of NSAIDs + rest

Question 43

what is perthes disease, what does it lead to

Answer 43

idiopathic osteochondritis of the femoral head which leads to avascular necrosis of the hip

Question 44

who most commonly gets perthes disease

Answer 44

active boys with short stature

Question 45

at what age does perthes disease occur

Answer 45

occurs between 4-9

Question 46

what are the symptoms of perthes disease

Answer 46

``` pain gradual onset of painless limp unilateral loss of internal rotation loss of abduction postive trendelenburg test = gluteal weakness ```

Question 47

what is the treatment of perthes disease

Answer 47

regular X-ray observation | avoid physical activity

Question 48

what is slipped upper femoral epiphysis (SUFE)

Answer 48

Occurs when the proximal femoral head epiphysis slips inferiorly in relation the femoral neck

Question 49

who is at risk of slipped upper femoral epiphysis (SUFE)

Answer 49

``` pre-pubertal, adolescent boys obese hypothyroidism renal disease growth spurt may preclude onset ```

Question 50

what are the symptoms of slipped upper femoral epiphysis (SUFE)

Answer 50

1/3 bilateral pain in knee and/or groin loss of internal rotation of the hip limp due to externally rotated foot

Question 51

what are the investigations of slipped upper femoral epiphysis (SUFE), what would these show

Answer 51

lateral X-ray = ice cream fallen off it's cone

Question 52

what is the treatment of slipped upper femoral epiphysis (SUFE)

Answer 52

urgent surgery to pin femoral head in order to prevent further slips