Orthopaedics (Unit 3: Orthopaedic Conditions in Childhood) Flashcards Preview

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Flashcards in Orthopaedics (Unit 3: Orthopaedic Conditions in Childhood) Deck (76)
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1

By what age does the average child sit independently?

9 months

2

By what age does the avergae child stand?

1 year

3

By what age does the average child normally walk?

20 months

4

What is the normal gap between the feet when a child stands to attention?

4cm

5

By what age should children with genu valgum & varus have developed normal allignment?

7 years

6

When is in-toeing exaggerated?

When children run

7

What are the 3 causes of in-toeing?

Femoral neck angle variation
Tibial torsion
Abnormal forefeet

8

Clinically how can children with an anteverted femoral head move their femur?

Can internally rotate their femur alot and externally rotate only a little

9

By what age should femoral neck angle variation correct itself by?

10 years

10

What is the treatment for tibial torsion?

It is normal variation and should be ignored

11

By what age should surgery on abnormal forefeet definitely not be considered before?

7 years

12

What are the 2 kinds of flat foot?

Rigid & mobile

13

What type are the majority of flat feet?

Mobile

14

What is a rigid flat foot?

Rare at any age
Underlying bony abnormality
Occasionally a sign of a serious disease such as RA

15

When might it be appropriate to operate on curly toes?

If causing severe discomfort in shoes

16

What is Osgood Schlatter's disease?

Inflammation of the attachment of the patellar tendon to the growing tibial ephiphysis caused by excess traction by the quadriceps

17

Who is Osgood Schlatter's more common in?

Very active children who are often involved in organised sport

18

What are the symptoms of Osgood Schlatter's?

Tenderness & discomfort which is worse after exercise (episodic)

19

When do symptoms of Osgood Schlatter's cease?

Middle adolescence when the epiphysis fuses

20

What is chondromalacia patellae?

When an area of patella cartillage is eroded (causes adolescent knee pain)

21

What might predispose a child to CDH?

Female
Familial & racial tendency

22

When are children screened for CDH?

Birth, 3, 6, & 12 months

23

What technique is used to diagnose CDH?

Barlow's (dislocate) & Ortolani's (relocate) manouevre

24

If missed in screening how might CDH present?

Shortening of the limb
Asymmetrical skin creases
Limited abduction
Limp

25

If a "click" is found on B & O what is the next step?

Re-examined in a specialist clinic at 3 months old (radiograph)

26

If a "clunk" is found on B & O what is the next step?

Should be treated from birth
Splintage required

27

What is the management of CDH if it is discovered late but not walking?

Period of gentle traction followed by open or closed manipulation then splintage for 3 months

28

What is the management of CDH if discovered late and walking has commenced?

Major surgery required to deepen undeveloped acetabulum and re-angulate femoral neck
Results are at best moderate and secondary arthritis is likely

29

What is talipes equino varus?

Deformity of the foot which makes it look like a golf club

30

What are the 2 forms of talipes equino varus?

Postural (mild)
Fixed

31

When is the postural mild form of talipes equino varus seen?

After a breech birth (probably related to baby's position in the womb)

32

What is the fixed form of talipes equino varus associated with?

Developmental abnormalities of nerves and muscles of the leg

33

Describe the initial treatment of talipes equino varus

Gentle strestching in two phases
1 - corrects hindfoot equinus
2 - corrects mid & forefoot varus

34

How long is treatment in mild forms of talipes equino varus?

6 weeks of stretching and srapping in a corrected ro over-corrected position

35

How long is treatment in severe cases of talipes equino varus?

6 weeks then reassessed
If incomplete surgery required

36

What age do feet on avergae stop growing?

14 years old

37

What is spina bifida occulta?

Minor bony abnormality usually of no significance

38

What orthopaedic problems might be caused by spina bifida occulta?

Mechanical backache
Diastamatomyelia

39

What is diastamatomyelia?

Tethering of the spinal cord to the higher lumber vertebrae during growth

40

What is spina bifida cystica?

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

41

What is a meningocele?

When the open neural plate tissues are covered by a cyst

42

What is a meningomyelocoele?

When the open neural plate tissue is incorporated in the cyst wall

43

What is hydrocephalus?

Abnormal increase in the amount of fluid in the brain which leads to mental retardation and increase in head size

44

What is the prognosis of spina bifida cystica?

Many die at or soon after birth
Those that survive with surgery have profound problems

45

What problems do children who survive surgery for spina bifida cystica suffer from?

Paralysis, growth deformities, muscle imbalance, incontinence

46

What orthopaedic problems need corrected in spina bifida cystica?

Feet
Joint contraction resulting in fixed flexed knees

47

In the treatment of children with spina bifida cystica what non-surgical management is important?

Keep mobile until adolescence so they can grow to a reasonable size

48

What is cerebral palsy?

Abnormality of the brain often cause by damage to the brain at birth that results in delayed or arrested development of the nervous and MSK systems

49

What would be found on a neuro exam of a child with CP?

Uninhibited spinal reflexes
Lack of coordination and purpose of movement

50

Why do patients with CP have a spastic type of paralysis?

Some muscles contract strongly in an uncoordinated way whilst others are very weak and flaccid

51

What are the clinical presentations of CP?

Hemiparesis
Paraparesis
Quadraparesis
Mental retardation
Blind and/or deaf
Some do not siffer mental or sensory impairment

52

What is a common presentation of a person with CP who has only minor degrees of spasticity?

Toe-walking in adolescence

53

What is the treatment for a CP adolescent with toe-walking?

Tendo-achilles lengthening

54

How can orthopaedic problems in CP be managed?

Careful physiotherapy
Cautious use of splintage
Careful use of surgery to either lengthen tight muscle or to denervate them or (occasionally) to move them

55

What is Scoliosis?

Curvature of the spine with a rotatory abnormality of the vertebrae

56

What can cause scoliosis?

Congenital abnormalities of the vertebrae
Neuromuscular imbalance
Idiopathic (most cases)

57

How does scolisosis present?

Twisting of the ribs which causes a hump on one side of the shoulder
Skirts hang crookedly

58

What ar indications for surgery in scoliosis?

Curve is progressive
Causing distress

59

What are 2 causes of a limp from birth?

CDH
Infection of the hip

60

What is the likely cause of a limp between the ages of four and ten?

Perthe's disease

61

What is the likely cause of a limp from age ten to fifteen?

SUFE

62

What is Perthe's disease?

Osteochondritis (fragmentation of the bone and overlying cartilage) of the femoral head epiphysis

63

How does Perthe's disease present?

Painful limp followed by slow recovery

64

What would investigations for Perthe's reveal?

Femoral head may be normal radiographically at first presentation but change when repeated after a month
US - excess fluid in hip joint

65

What is the pathological process of Perthe's disease?

AVN of the growing femoral head
Will eventually re-vascularise and re-ossify but may be enlarged and deformed

66

What is the strategy of management for Perthe's disease?

Maintain head concentrically within the acetabulum until the natueral process of the disease runs it's course

67

What are older children who develop Perthe's prone to?

Secondary arthritis

68

What are the treatment options for severe Perthe's disease/

Splintage may help
Osteotomy (enlarge acetabulum or redirect femoral head)
Careful follow-up with periods of traction

69

What pateint demographic does SUFE present in?

Boy around 12 y/o who are sexually immature
Girls who are a little older and have recently undergone an adolescent growth spurt

70

What is SUFE?

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

71

How does SUFE present?

Limp
Pain radiating to knee

72

Which nerve causes pain to radiate to the knee in SUFE?

Obturator

73

What view must be included when imaging a suspected SUFE?

Lateral (so minor degrees of slippage aren't missed0

74

What is the surgical management of SUFE if the slippage in minor?

Pinned in its new deformed position

75

What is the surgical management of SUFE if the slippage is major?

Gentle attempt to replace head on neck by manipulation (risk of AVN is high)

76

When should pins for SUFE be removed?

After fusion of the epiphysis at around 18 y/o