msk cortex - paediatric orthopaedics

Question 1

What type of collagen disorder is osteogenesis imperfect a

Answer 1

Type 1

Question 2

How does osteogenesis imperfecta present

Answer 2

Blue sclera
Fragility fractures
Short stature with multiple deformities
Loss of hearing

*aka brittle bone disease

Is autosomal dominant

Question 3

What is the most recognised type of skeletal dysplasia

Answer 3

Achondroplasia - disproportionately short limbs with a prominent forehead and widened nose

Question 4

What type of collage results in joint hypermobility

Answer 4

Type 1 - mainly affects bone tendon and ligaments

Question 5

Eye problems associated with Marfan’s

Answer 5

Lens dislocation and retinal detachment

Question 6

Heart problems associated with Marfans

Answer 6

Aortic aneurysm
Cardiac valve abnormalities

Question 7

What type of inheritance pattern are muscular dystrophies

Answer 7

Usually x-linked recessive (only affects boys)

Question 8

What is Gower’s sign?

Answer 8

+ duchenne muscular dystrophy

Question 9

Prognosis of patients with duchenne muscular dystrophy

Answer 9

Poor :(

By age 20 there is progressive cardiac and respiratory failure —> death in the early 20s usually

Question 10

Diagnosis of duchenne muscular dystrophy

Answer 10

Raised serum creatinine phosphokinase and abnormalities on muscle biopsy

Question 11

Management of duchenne muscular dystrophy

Answer 11

Physiotherapy
Splintage
Deformity correction
Severe scoliosis can be corrected by spinal surgery

Question 12

What is the most common type of Cerebral palsy

Answer 12

Spastic - 80%

Question 13

Non-pharmacological treatment of cerebral palsy

Answer 13

Physiotherapy
Splintage

Question 14

Management of Cerebral palsy

Answer 14

Baclofenac - given in the subarachnoid space
Botox - reduce spasticity

Surgery - hip excision or replacement to treat a painful hip dislocation

Question 15

What is spina bifida

Answer 15

Two halves of the posterior vertebral arch fail to fuse

There are two types - oculta and cytsica

Oculta = pes cavus
Cystica = herniating of vertebral canal - type of myelomeningoceal

Question 16

What is Erb’s palsy

Answer 16

Type of obstetric brachial plexus palsy

With injury to the upper C5-C6 nerve roots resulting in loss of motor innervation of deltoid , supraspinatus , infraspinatus , biceps and brachialis muscles

Question 17

*waiter’s tip posture

Answer 17

Erb’s palsy

Due to internal rotation of the humerus

Question 18

Treatment of Erb’s palsy

Answer 18

Physiotherapy —> good prognosis

Surgical release of contracture and tendons also may be required if there is no recovery

Question 19

What is Klumpke’s palsy ?

Answer 19

Another brachial plexus palsy - and is due to injury or lower brachial plexus roots (C8-T1)

Leads to paralysis of intrinsic hand muscles

Question 20

Parents worried about child of 3 years knees - concerns of knock knee . What to do ?

Answer 20

Reassure

Vast majority develop normal alignment by age 7-9years

Question 21

What is considered pathological varus of valgus ?

Answer 21

+/- 6 degrees from normal range from mean value for age

Question 22

Causes of genu valgum and Varum

Answer 22

Rickets
Trauma
Bone tumours

Question 23

Causes of in-toeing

Answer 23

Femoral neck anteversion

Internal tibial torsion

Forefoot adduction

Question 24

T/F all feet are flat when born

Answer 24

True

Question 25

Treatment of flexible ped planus

Answer 25

In children is a normal variant Adults - may be related to tibialis anterior tendon dysfunction

Question 26

What is the rigid type of flat footedness

Answer 26

When dorsiflexion of great toe doesn’t affect arch - remains flat Usually due to tarsal coalition May require surgery

Question 27

After Ortolani and Barlow on suspicion of DDH - which investigation is next ?

Answer 27

Ultrasound (X-rays cannot be used for early diagnosis of DDH as femoral head epiphysis is unossified until 4-6months - after this then X-rays are the preferred modality of choice)

Question 28

Management of DDH if persistent dislocation after 18months old

Answer 28

Open reduction

Question 29

Most common cause of hip pain in childhood

Answer 29

Transient synovitis of the hip

Question 30

How does transient synovitis of the hip present ?

Answer 30

Limp Reluctance to weight bear Range of motion may also be restricted

Question 31

Treatment of transient synovitis

Answer 31

Short course of NSAIDs + rest Generally resolves in a few weeks , but if persists then consider another cause of hip pain

Question 32

Who gets Perthes disease

Answer 32

Very active boys that are short

Question 33

What is Perthe’s

Answer 33

The femoral heads transiently loses its blood supply resulting in necrosis with subsequent abnormal growth The femoral head may collapse on fracture —> subsequent remodelling occurs however the head shape and congruence depends on age —> can lead to early onset arthritis

Question 34

How does perthes present

Answer 34

Hip pain and limp Pain is usually unilateral Loss of internal rotation is the first clinical sign , then loss of abduction and later a + Trendelendburg from gluteal weakness

Question 35

Treatment of Perthes’

Answer 35

X-ray surveillance is all that is needed in 50% However some may need osteotomy

Question 36

How does SUFE present ?

Answer 36

Hip pain (bilateral usually) Limp Pain may radiate to groin Can also present with only knee pain ! (Obturator nerve)

Question 37

Treatment of SUFE

Answer 37

Urgent surgery to pin femoral head from further slipping out In some severe cases may need hip replacement in early adulthood

Question 38

What is important to remember when someone is presenting with solely knee or hip pain ?

Answer 38

Could be referred pain from either (obturator nerve) Ie knee pain but problem is with the hip

Question 39

Treatment of Osgood Schlatters

Answer 39

Rest and physio

Question 40

Treatment of patellar tendonitis

Answer 40

Self - limiting Rest + physio is all that is needed

Question 41

What is clubfoot

Answer 41

Congenital deformity of foot due to abnormal alignment of joints between talus, calcaneus, and navicular 50% cases are bilateral

Question 42

How does clubfoot present ?

Answer 42

Ankle equinus / plantarflexion Supination of forefoot Varus alignment of the forefoot

Question 43

Who gets clubfoot

Answer 43

Boys are doubly likely to get this Also breech presentation and family history

Question 44

Treatment of clubfoot

Answer 44

Early diagnosis = Splintage ‘ponsetti’ Late diagnosis —> not so great as difficult to correct as they develop fixed flexion deformity = surgery

Question 45

What is the Ponseti technique ?

Answer 45

In treatment of early diagnosed clubfoot Foot held in plaster cast with 5-6 weekly changes 80% of children with clubfoot require tenotomy to maintain a full correction

Question 46

Treatment of hallucx valgus

Answer 46

Surgical correction

Question 47

What is spondylolisthesis

Answer 47

Slippage of one vertebra over another and usually occurs at L4/L5 or L5/S1

Question 48

How does spondylolithesis present

Answer 48

Low pack pain Radiculopathy (severe) ‘Flat back’ Waddling gait (acutely)

Question 49

Treatment of slipped vertebra

Answer 49

Minor slip = observation + rest + physio Major = stabilisation and possibly reduction