Orthopaedics Flashcards Preview

PAEDS > Orthopaedics > Flashcards

Flashcards in Orthopaedics Deck (54):
1

Ossification of the hindfoot

Calcaneus: 23 weeks gestation
Talus: 28 weeks gestation

2

Ossification of midfoot

Cuboid: 6-7 months
Navicular: 9/12 to 5yrs
Cuneiforms: 3-12 to 2.5 years. Lateral cuneiform first

3

Ossification of forefoot

Metatarsals and phalanges: usually present at birth

4

Anatomy of CTEV deformity

Equines (PF) at talocrural joint
Add and Inv at subtler (talocalcaneal) and mid tarsal joints. Navicular tuberosity close to medial malleolus
Metatarsal's Add

5

Observations of Postural CTEV

No evidence of thick medial crease, tight lateral skin or poorly developed heel

6

PT Management of Postural CTEV

AROM
PROM
Taping (Buckle and Strap)
Follow up

7

Key feature of structural CTEV

Osseous deformities evident
Soft tissue contractors evident
Can't be corrected actively or passively
Thick medial crease, tight lateral skin and poorly developed heel

8

Causes of structural CTEV

Congenital idiopathic rigid/structural TEV
Idiopathic
Developmental arrest of talus during 9th week of gestation

9

Pirani and Outerbridge 6 clinical signs of contracture

Posterior contracture:
Posterior crease
Empty heel
Rigid Equines

Medial contracture:
Curvature of lateral border of foot
Medical crease
Bony lump on lateral part of head of talus

10

Ponseti Order of correction

1. Correct the caves
2. Realign the forefoot, mid foot and hind foot
3. DF
4. Over-correction

11

Describe Congenital Vertical Talus

Hindfoot in PF
Talus vertical
Talo-navicular joint subluxed
Forefoot and and DF
"Rocker bottom foot"

12

Name 7 factors influencing MSK development

Nutrition
Hormones
Genetics
Drugs
Mechanical forces
Injury/Trauma
Intervention

13

Discuss the types of mechanical forces

1. Prenatal forces: abnormal maternal structures, decrease intra-uterine space
2. Postnatal forces: Habitual positioning and abnormal loading

14

Change in femoral ante version and tibial torsion from birth to skeletal maturity

Femoral anteversion: 40 degres at birth to 15 degrees at maturity
Tibial torsion: 5 degrees ER at birth to 15 degrees at maturity

15

Contributors to in-toeing

1. Internal tibial torsion (>10 = abnormal)
2. Metatarsus Adductus

16

Contributors to out-toeing

1. External tibial torsion (>30 abnormal)

17

Hip rotation for femoral anteversion ranges

MR: >70 = anteversion
LR: >20 = anteversion

18

Describe postural changes at legs

18 months - bow legs (gene varum)
3-4 years - knock knees (genu valgum)
6 years - legs straight

19

Classification of DDH

Subluxable: femoral head can be partially displaced to rim of acetabulum
Dislocatable: femoral head is in socket but can be displaced completely outside acetabulum with manual pressure
Dislocated: femoral head lies completely outside hip socket but can be reduced with manual pressure
Teratologic: femoral head lies completely outside hip socket and can't be reduced with manual pressire

20

Causes of DDH

Positioning in utero
Hormonal influences
Genetic pre-disposition
Swaddling practices

21

Characteristics of BJHS

1. Generalised joint hypermobility/laxity
2. Chronic joint pain
3. Other MSK signs related to defect in collagen
4. No rheumatological disease
5. Strong genetic pattern

22

5 signs of achondroplasia in UL

1. Rhizometric shortening of humerus
2. Limited elbow ext
3. Limited forearm supination
4. Trident appearance of hand
5. Short fingers

23

7 signs of achondroplasia in LL

1. Trident pelvis
2. Rhizometric shortening of Femur
3. Decrease acetabular angle
4. Genu varum
5. Expanded metaphases at knee
6. Long fibula
7. Short toes

24

MSK signs of DMD

1. Hyperlordosis of spine
2. Muscle contractures of Achillies and hamstrings
3. Pseudohypertrophy in calf muscles and tongue
4. Scoliosis (neuromuscular)

25

Developmental signs of DMD

1. Lack of balance
2. Unusual/Awkward gait
3. Difficulty with synergistic motor program
4. Loss of ability to walk at 12 years
5. Difficulty getting up from ground

26

Features of SMA

System wide muscle wasting
Mobility impairment
Loss of strength of respiratory muscles
Arreflexia
Difficulty achieving developmental milestones

27

DDH Observations

Unequal creases in buttocks or thighs
Difficulty abducting legs
Leg length inequality

28

Presentation of Perthe's disease

1. Painful limp
2. Limitation of IR/Abd at hip

29

Most common sites for osteosarcoma

1. Metaphysis of distal femur
2. Proximal tibia
3. Proximal humerus
4. Proximal femur

30

Describe non-structural scoliosis

Flexible curve that corrects on side bending
Reversible
Psychological disorder
Pain in LEX
Back pain
Compensatory

31

Describe structural scoliosis

Segment of spine curved and not reversible with any type of treatment or postural change

32

What is the Risser Sign

Ossification from ASIS to PSIS

33

Gold standard of scoliosis Mx

0-25 = observe
25 -40 = brace
>40 = consider surgery

34

Features of neuromuscular scoliosis

long C-shaped collapsing curve
Kyphotic of scoliotic collapse
+/- pelvic obliquity

35

Cause of physeal injuries and what they are + classification

Infection
Tumour
Ischaemia
Fracture to sone of provisional calcification
Salter-Harris classification

36

Describe Salter-Harris classification

1. Separation through physis
2. Through physis with metaphyseal fragment
3. Fracture through epiphysis not extending into metaphysics
4. Fracture through epiphysis and metaphysis
5. Stress injury due to abnormal pressure across physis
6. Crush injury to periphery of physis

37

Complications of bone trauma

Avascular necrosis
Compartment Syndrome
Malunion
Physical damage
Nerve/arterial injury
Infection

38

2 tests use for DD of pes planus

Great toe ext
Tip toe test

39

Treatment for CVT

REFER

40

Normal foot progression angle

-5 - +20

41

Conditions associated with PCTEV

Torticollis
Facial deformity
Plagiocephaly
Hip dislocation
Metatarsus Adducts
Postural TEV

42

PT Rx for BJHS

1. Low impact exercise
2. Joint stability - isometrics & postural correction
3. Lifestyle modifications
4. ROM - stretch tight overused muscles
5. Pain Mx
6. Proprioception

43

MSK issues for Rx in EDS

Hyperflexible joints - unstable
Joint and tissue degeneration - early onset OA
Spinal deformities
Pain
Trendelenburg

44

Mx of OI

Strengthen muscles and improve flexibility to decrease deformity
Improve endurance
Regular position changes to balance muscles being used and bones under pressure
Hydro
Aids - cushions, mobility, splinting (pain relief)
A&E

45

Signs of SCFE

Adolescent males
Acute/Chronic presentation
Referred to thigh/knee
Hold leg in ER
Leg Length discrepancy

46

Signs of Osteosarcoma

Pain at rest
Reluctance to WB
Swelling

47

PT Mx post surgery Osteosarcoma

Maintain ROM/Strength
Manage pain
Functional mobility

48

National Physical activity guidelines?

0-1: supervised floor play throughout day
1-5: three hours per day

49

What is Cranial Index and what does it measure?

Measures AP/Lateral diameters of head; determines degree of posterior or lateral flattening; bracicephaly, plagiocephaly

50

Rx for plagiocephaly

1. Active Baby
2. Balanced handling
3. Corrective strategies

51

Features of congenital scoliosis

1. Present in-utero
2. Often rigid
3. Rib deformities +/- fused ribs
4. Requires unique and creative management
5. Limitless variations of presentation
6. 75% progress
7. Bracing unsuccessful

52

6 features of children's bones

1. Thick periosteum
2. Thick articular cartilage
3. Increased collagen content
4. More cancellous bone
5. Growth plates
6. Stronger ligaments

53

Indications for ORIF

S-H 3 and 4
Displaces articular fractures
Lateral condylar fractures (elbow)
Supracondylar fractures (elbow)
Polytrauma

54

What needs to be stretched in babies with Spinal Bifida?

Hip flexors
Knee extensors