Orthopaedics Unit 3 Flashcards Preview

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Flashcards in Orthopaedics Unit 3 Deck (71):
1

what are the average age for child to sit independently, stand and walk

sit - 9 months

stand - 12 months

walk - 20 months

[however is a lot of variation, not always a problem if child does not reach the milestone at this point]

2

what is the medical term for knock knees

genu valgum

3

what is the medical term for bow legs

genu varum

4

what is the normal alignment of the knee

in valgus

when child stands to attention, normally a gap of 4cm between the FEET

5

how does the gap change between the feet in varus and valgus

varus - gap decreases

valgus - gap increases

6

what is important to note in relation to genu varum and genu valgum in children

almost all children by the age of 7 with this condition will have normal knee alignment t

7

what is in-toeing and how can you spot it

children stand with their feet pointing inwards "pigeon-toed"

often exaggerated when they run and causes clumsiness

shoes tend to wear down at the heels

8

what are causes of in-toeing

femoral neck angle variation

tibial torsion

abnormal forefeet

9

how does femoral neck angle variation develop

During later stages of the normal development of foetus, the leg rotates on the pelvis so that the acetabulum points almost backwards and the femoral head on the neck is orientated forwards

sometimes this process is not completed by birth and the femoral neck is more anteriorly orientated (i.e. anteverted)

10

what can children who are born with femoral neck angle variation do more than other children

internally rotate their femur a lot and externally rotate it only a little
- causes the in-toeing posture

11

when is femoral neck angle variation often corrected by

10 y/o

surgery rarely needed

12

what is tibial torsion

bone is warped along vertical axis

is normal variation and can be ignored

13

what is abnormal forefeet

hooked (adducted) forefoot

vast majority correct spontaneously

14

what is important to remember about flat foot

it is normal variation which rarely causes functional abnormalities

all children's feet are flat at birth, normal arch may not form until child is 7

15

what are the 2 types of flat foot

rigid
- rare
- implies bony abnormality
- sometimes seen in RA

mobile
- vast majority
- no issue

16

what is curly toes

minor overlapping, commonly of the 5th toe

most correct spontaneously and should be left alone

17

when would surgery on curly toes be required

if the overlapping toes becomes fixed or if people are getting discomfort from shoes

18

when is pain around the knee most common in girls

as they develop secondary sexual characteristics.

19

what is Osgood Schlatter’s disease

inflammation of the attachment of the patellar tendon to the growing tibial epiphysis, caused by excess traction by the quads

20

Sx of Osgood Schlatter’s disease

tenderness, discomfort worse after exercise

swelling

21

what are features of the Osgood Schlatter’s disease

thought to be overuse injury, seen most common in active children

episodic
Tx w/ rest

22

when will children cease to have Osgood Schlatter’s disease

in middle adolescence when the epiphysis fuses

23

what is features of adolescent knee pain

most common in girls

not the same as dislocation of patella

most girls grow out of the condition

if Sx persist, arthroscopy may be necessary

24

what is chondromalacia patellae

erosion of an area of patella cartilage

25

what is the rate of Congenital Dislocation of the Hip (CDH) [or congenital hip dysplasia CHD]

occurs in 1 or 2 births per thousand

26

epidemiology of CHD

girls > boys
significant number of children, condition is bilateral

27

what is the screening program for CHD

screened at birth, 3 months, 6 months and 12 months

28

what are the two screening tests for CHD and what are they doing

Barlow maneuver
- adduct the hip, apply light pressure
- if hip dislocates = +ve test

Ortolani test
- try to relocate the hip
- if you hear a click or a clunk = +ve test

29

what are the Sx of CHD if it is not discovered till later life

shortening of the limb

asymmetrical skin creases

limited abduction

limp

30

what should be the next stages if a "click" is heard in CHD

re-examined by specialist at 3 months

radiograph

31

Mx of CHD

Tx from birth
- Pavlik harness

Tx if discovered late but before weight bearing
- period of gentle traction followed by open or closed manipulation
- then splinted in plaster for 3 months

Tx if discovered late and is weight bearing
- major surgery to deepen the undeveloped acetabulum and re-angulate the femoral neck to stabilise the hip

32

why is it important to Tx CHD from birth

If the femoral head is relocated and maintained in the acetabulum using splintage then the vast majority will settle with no further development issue

33

what is the issue with the Tx of CHD if discovered late and child is weight bearing

results are at best moderate,

Secondary OA is highly likely.

34

what is the medical name for club foot

Talipes Equino Varus

35

what are the 2 types of club foot

postural form (mild)
- seen after breech birth

fixed form
- associated with development abnormalities of nerves and muscles of the leg

both CAN BE bilateral (not always)

36

Mx of mild talipes equino varus

initial Tx for both forms
- gentle stretching in two phases
- 1st phase = corrects hindfoot equinus
- 2nd phase = corrects mid and forefoot varus

= 6 weeks of stretching and strapping in a corrected or over-corrected position

37

Mx of fixed talipes equino varus

6 weeks of stretching

Reassessed - if correction is incomplete or cannot be maintained

Surgery

38

what is the follow up period for talipes equino varus

until feet stop growing
- around age 14

[affected foot often significantly smaller than normal foot which causes difficulties in shoe fitting]

39

what are the 2 types of spina bifida

spina bifida occulta

spina bifida cystica

40

what is spina bifida occulta

minor bony abnormality which affects 2% of the population
- usually of no significance

develop mechanical backache

41

what is a possible consequence of spina bifida occulta

diastamatomyelia
- tethering of the spinal cord to the higher lumbar vertebrae

42

what is spina bifida cystica

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

43

what is a meningocele

nerve tissue covered by a cyst

44

what is meningomyelocele

nerve tissue may be incorporated in the cyst wall

45

what are the consequences of spina bifida cystica

hydrocephalus
> can lead to mental retardation

paralysis

growth deformities [due to muscle imbalance]

incontinence

joint contraction resulting in a fixed flexed position of their knees and dislocation of their hips

46

Mx of spina bifida cystica

most babies die at, or soon after, birth

some survive to undergo surgery
- early surgery to feet to maintain functional shape
- try to keep the children mobile

47

what causes cerebral palsy

damage to the brain at birth

48

what are the pathological features of cerebral palsy

spinal tissue develops normally
> have uninhibited spinal reflexes
> lack co-ordination and purpose of movement, normally controlled by the brain
> causes SPASTIC PARALYSIS

abnormal muscle and bone growth
> due to some spastic muscle [muscles contracting strongly in uncoordinated way]
> and due to some muscles being weak and flaccid

secondary deformities of joints

49

what are the patterns of cerebral palsy

Hemiparesis
- 1 arm and 1 leg on the SAME side

Paraparesis
- 2 legs are affected

Quadraparesis
- all limbs affected

50

what are other Sx of cerebral palsy

some are mentally retarded

some are blind and/or deaf

some are neither

51

what is the management of patients with only minor degrees of spasticity

spasticity may only affect 1 muscle group
- common sign is toe-walking in teens
- often calf muscle spasticity

Tx = tendo-achilles lengthening before growth ceases

52

Mx of cerebral palsy

similar to spina bifida

maintain mobility

physiotherapy

surgery to lengthen tight muscles or to denervate them to maintain posture and function

53

what is scoliosis

Curvature of the spine with a rotatory abnormality of the vertebrae

54

what causes the curve of the spine in scoliosis

abnormal lordosis of the spine, which leads to buckling and twisting of the vertebral column as a result of the action of muscles and gravity.

55

what is the aetiology of scoliosis

most are idiopathic
- seen in adolescence
- girls more than boys
- principal effects are cosmetic but cause great distress

can be caused by congenital abnormalities of the vertebrae or by neuromuscular imbalance

56

clinical presentation of scoliosis

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

skirts hang crooked

may be painful

57

Mx of scoliosis

not all curves get worse

if curve is progressive or causing distress Tx should be offered early
- surgical correction of the ROTATORY element of the deformity

58

what is the most likely cause of a limp at birth, between 4-10 and between 10-15

birth
- CDH
- infection of the hip

between 4 and 10
- Perthe's disease

between 10 and 15
- SUFE

59

what is Perthe's disease

blood supply to the femoral head epiphysis becomes inadequate

causes AVN of the femoral head

60

aetiology of perthe's disease

more common in boys than girls

20% of cases are bilateral

61

clinical presentation of perthe's disease

child has painful limp which is followed by a slow recovery

62

radiological appearance of perthe's disease

femoral head may be normal on 1st presentation
- month later it may show changes

USS reveals fluid around hip joint

63

Mx of Perthe's disease

maintain the head within the acetabulum until the natural process of the disease runs its course

minor cases [up to half of femoral head involved]
- need no Tx
- good prognosis

severe cases
- splintage to achieve containment
- Careful follow-up with periods of traction to alleviate symptoms of pain and limp

64

what are children who have had Perthe's disease at an older age prone to

secondary OA

65

what is SUFE

slippage of the epiphysis of the femoral head on the femoral neck so that the head is abnormally tilted.

66

aetiology of SUFE

seen mostly in boys around 12 y/o who are sexually immature for their age

and in girl who are little older and have recently undergone an adolescent growth spurt

67

clinical presentation of SUFE

child has a limp

may be pain radiating to the knee [due to the obturator nerve supplying both the hip and knee joint]

ANY CHILD WITH KNEE PAIN HAS TO HAVE THEIR HIP EXAMINED

loss of internal rotation of the hip is the predominant clinical sign

68

what imagining must be obtained for SUFE and why

a lateral view or minor degrees of slippage may be missed

69

if a child has hip pain, what is the working diagnosis

All young adolescents with a painful hip must be regarded as having SUFE until it is clinically and radiologically excluded

70

Mx for SUFE

Tx is always surgery

Minor slippage
- hip should be pinned in its new deformed position

Major slippage
- gentle attempt to replace the head on the neck by manipulation
- does carry risk of AVN

Always observe the other hip for slippage using imaging
- pinned if any slippage

71

when are the pins from surgery removed in SUFE

removed after fusion of the epiphysis at around eighteen years of age.