ortho conditions in childhood

Question 1

average child usually sits by what age

Answer 1

9 months

Question 2

average child usually stands by

Answer 2

1 year

Question 3

average child usually walks by

Answer 3

20 months

Question 4

by what age are most cases of genu varum and valgum normally corrected

Answer 4

age 7

Question 5

causes of in-toeing

Answer 5

femoral neck anteversion
tibial torsion
abnormal forefeet

Question 6

femoral neck ante version means the femur can be ? rotated a lot

Answer 6

internally rotated a lot

Question 7

is tibial torsion a normal variation

Answer 7

yes and should be ignored

Question 8

surgery to correct abnormal forefeet should not be considered until after age ?

Answer 8

7

Question 9

is flat foot normal variation

Answer 9

yes

Question 10

most types of flat foot are ?

Answer 10

mobile

Question 11

are all childrens feet flat at birth

Answer 11

yes

Question 12

what does rigid flat foot usually imply

Answer 12

underlying bony abnormality

occasionally its a sign of serious disease such as RA

Question 13

what is osgood schlatter’s disease

Answer 13

inflammation of the attachment of the patellar tendon to the growing tibial epiphysis

Question 14

what causes the inflammation in osgood schlatter’s disease

Answer 14

excess traction by the quadriceps

Question 15

what is rarely seen in adolescent knee pain

Answer 15

chondromalacia patellae - eroded area of patellar cartilage

Question 16

eroded area of patellar cartilage

Answer 16

chondromalacia patellae

Question 17

how common is CDH

Answer 17

one or two live births per thousand

Question 18

is the hip usually completely dislocated at birth in CDH?

Answer 18

rarely

Question 19

CDH more common in girls or boys?

Answer 19

girls

Question 20

what kind of tendency is there in CDH

Answer 20

familial and racial

Question 21

when should children be screened for CDH?

Answer 21

at birth
3 m
6m
12 m

Question 22

clinical signs of CDH

Answer 22

limb shortening
asymmetrical creases
limited adduction
limp

Question 23

what is the next step of action if the CDH test produces a click

Answer 23

re examination at 3 m in a specialist clinic - radiograph usually justified

Question 24

next step of action if CDH is discovered late but before weight bearing

Answer 24

gentle traction followed by open or closed manipulation

followed by splintage for

Question 25

next step of action in CDH if discovered late and walking has commenced

Answer 25

major surgery to deepen the undeveloped acetabulum and re-angulate the femoral neck secondary arthritis is highly likely

Question 26

when is the mild, postural form of club foot seen

Answer 26

after breech | usually easily corrected at birth by manipulation

Question 27

what is the fixed form of club foot associated with

Answer 27

developmental abnormalities of nerves and muscles of the leg

Question 28

initial tx for club foot

Answer 28

in both forms: gentle stretching in 2 phases 1. correction of hind foot equinus 2. corrects the mid and forefoot varus for 6 weeks

Question 29

Until when do children with club foot need to be followed up

Answer 29

until their feet stop growing (around age 14)

Question 30

why is follow up for club foot important?

Answer 30

late relapse requiring surgery is not uncommon

Question 31

the affected foot in clubfoot is usually significantly larger than the normal foot - true or false?

Answer 31

false - usually SMALLER

Question 32

is spina bifida occulta usually of significance?

Answer 32

usually not!

Question 33

some people who are affected by spina bifida occult develop what? a very small number may get what?

Answer 33

some people get mechanical backache a very small number get tethering of the spinal cord to the higher lumbar vertebrae during growth ("diastamatomyelia")

Question 34

what is diastamatomyelia?

Answer 34

tethering of the spinal cord to the higher lumbar vertebrae during growth

Question 35

what is spina bifida cystica?

Answer 35

baby is born with the neural plate tissues open with little or no skin or bony cover

Question 36

what do many children with spina bifida cystica also have?

Answer 36

hydrocephalus

Question 37

hydrocephalus leads to mental retardation - t or f

Answer 37

true

Question 38

whats it called when nerve tissue is covered by a cyst

Answer 38

meningocele | meningomyocele if nerve tissue is incorporated into cyst wall

Question 39

can spina bifida cystica be life threatening?

Answer 39

yes, many children die at or soon after birth

Question 40

long term complications of spina bifida cystica

Answer 40

paralysis growth deformities through muscle imbalance incontinence many are mentally retarded

Question 41

many children with spina bifida cystic need early surgery to their ?

Answer 41

feet - to maintain a functional shape

Question 42

if a child with spina bifida cystica develops joint contraction what can this result in?

Answer 42

fixed flexion of knees and dislocation of hips

Question 43

children with spina bifida cystica should be encouraged to do minimal movement - t or f

Answer 43

false - they should keep mobile until adolescence so that they may grow to a reasonable size

Question 44

in CP does spinal tissue develop normally?

Answer 44

yes, so they have uninhibited spinal reflexes

Question 45

in terms of movement what do people with CP lack? what does this result in?

Answer 45

they lack co-ordination and purpose of movement normally controlled by the brain, resulting in a spastic type of paralysis

Question 46

what causes joint deformity in CP

Answer 46

some muscles contract strongly (spastic) and some are weak and flaccid >> imbalance >> abnormal muscle and bone growth >> joint deformity

Question 47

name of CP where 2 legs are affected

Answer 47

paraparesis

Question 48

a common sign of minor degree of spasticity seen in adolescence

Answer 48

toe walking

Question 49

splintage should be used frequently in CP - true or false?

Answer 49

false - it should be used with caution as too much can lead to increased muscle spasm and deformity

Question 50

what is scoliosis

Answer 50

curvature of the spine with a rotary abnormality of the vertebrae

Question 51

when do most cases of idiopathic scoliosis occur

Answer 51

adolescence

Question 52

Is scoliosis more common in girls or boys?

Answer 52

far more common in girls

Question 53

With scoliosis what does the child usually complain of?

Answer 53

twisting of the ribs which causes a hump on one side of the shoulder

Question 54

do braces have a role in scoliosis

Answer 54

no

Question 55

causes of a limp from birth

Answer 55

CDH | infection of the hip

Question 56

cause of a limp between age 4 and 10

Answer 56

Perthe's

Question 57

cause of a limp from 10 to 15

Answer 57

SUFE

Question 58

what is Perthe's?

Answer 58

an osteochondritis of the femoral head epiphysis

Question 59

what percentage of cases of Perthe's are bilateral

Answer 59

20%

Question 60

presentation of Perthe's

Answer 60

painful limp followed by a slow recovery

Question 61

what does U/S reveal in Perthe's

Answer 61

excess fluid in the hip joint

Question 62

what is Perthe's thought to be caused by?

Answer 62

avascular necrosis of the growing femoral head

Question 63

strategy of treatment in Perthe's

Answer 63

to maintain the head of the femur concentrically within the acetabulum until the disease runs its course

Question 64

if involving up to half the femoral head, does Perthe's need tx?

Answer 64

no - prognosis is good

Question 65

is prognosis for Perthe's better in younger or older children?

Answer 65

younger

Question 66

what can be done in Perthe's to alleviate pain and limp?

Answer 66

traction

Question 67

Who is SUFE seen in?

Answer 67

boys age 12 who are sexually immature for their age | girls a little older who have recently undergone an adolescent growth spurt

Question 68

what nerve causes SUFE to sometimes cause knee pain?

Answer 68

obturator

Question 69

is the limp always painful in SUFE?

Answer 69

no

Question 70

what must radiographs in suspected SUFE include?

Answer 70

lateral view

Question 71

management of SUFE

Answer 71

surgical - if minor slippage, pin in new deformed position - if major slippage, may attempt to replace the head although this comes with high risk of AVN - observe other hip!! pin if an sign of slippage

Question 72

when are pins from SUFE surgery best to be removed?

Answer 72

after epiphyseal fusion at around 18 y/o