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MB2 Rheumatology and Orthopaedics > Paediatric and congenital orthopaedics > Flashcards

Paediatric and congenital orthopaedics Flashcards

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1
Q

what is osteogenesis imperfecta and autosomal dominant/recessive is more common

A

defect in maturation and organisation of type I collagen

autosomal dominant

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2
Q

how would bones appear in osteogenesis imperfecta

A

thin cortices

osteopenia

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3
Q

features of achondroplasia, proportionate/disproportionate, inheritance

A

disproportionate short limbs, prominent forehead and wide nose, joint laxity
autosomal dominant but usually sporadic

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4
Q

complicating features of skeletal dysplasias

A 
learning difficulty 
spine deformity 
atlantoaxial subluxation 
cord compression 
joint hypermobility 
tumour 
organ dysfunction
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5
Q

patients with general joint laxity are more prone to?

A

dislocations and sprains - especially joint and patella

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6
Q

what is marfans syndrome

A

autosomal dominant/sporadic mutation of fibrillin gene leading to tall stature with disproportionately long arms and joint laxity

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7
Q

features of marfans syndrome

A

scoliosis, long arms, tall stature, joint laxity, high arch palate, aortic/mitral regurgitation, pectus excavatum, aortic aneurism/dissection

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8
Q

what is ehlers-danlos syndrome and common features?

A

heterogenous condition with autosomal dominance affecting collagen and elastin
easy bruising, vascular fragility, joint hypermobility and instability, scoliosis

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9
Q

what is duchenne muscular dysytrophy

A

x linked recessive dystrophin mutation in calcium transport causing progressive muscle weakness

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10
Q

what is CP

A

neuromuscular disorder with onset <2-3 due to immature brain before, during or after birth

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11
Q

causes of CP

A 
genes 
brain malformation 
issues during labour 
meningitis 
intrauterine infection 
intra-cranial haemorrhage 
hypoxia during birth
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12
Q

most common type of CP

A

spastic

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13
Q

what does ataxic CP affect

A

cerebellum

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14
Q

features of athetoid CP

A

writhing, changes in tone and difficulty with speech

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15
Q

MSK manifestations of CP

A

hip dislocation, joint contacture, scoliosis

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16
Q

what is spina bifida

A

congenital defect where two halves of the vertebral arch fail to fuse
mildest is spina bifida occulta and most severe is spina bifida cystica

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17
Q

who is obstetric brachial plexus palsy more common in

A

larger babies, twins, shoulder dystocia

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18
Q

what nerve roots does erb’s palsy affect

A

C5-C6 upper nerve roots

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19
Q

what nerve roots are affected in klumpke’s palsy

A

C8-T1

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20
Q

at what age should a child be able to sit alone/crawl

A

6-9 months

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21
Q

at what age should a child be able to stand

A

8-12 months

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22
Q

at what age should a child be able to walk

A

14-17 months

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23
Q

at what age should a child be able to jump

A

24 months

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24
Q

at what age should a child be able to manage stairs independently

A

3 years

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25
at what age should a child be able to move head
8 weeks
26
at what age should a child be able to speak a few words
9-12 months
27
at what age should a child be able to use a spoon or fingers eating
14 months
28
at what age should a child be able to stack 4 blocks
18 months
29
at what age should a child be able to understand 200 words and learn 10 new words/day
18-20 words
30
at what age should a child be able to be potty trained
2-3 years
31
describe child lower limb development
at birth children have varus legs that become neutrally alligned, then 10-15 degrees valgus at 3 years before 6 degrees valgus at 7-9 years old
32
what is femoral neck anteversion
femoral neck is slightly pointed anterior so gives appearance of intoeing and knock knee
33
describe formation of arch of foot
all feet flat at birth anf as we walk muscles develop to cause arch to form
34
true/false - flat feet is a problem
false - not always, it can be normal variation
35
what is jacks test
dorsiflexion of great toe causes arch of foot to form, positive sign of flexible flat footedness
36
causes of flexible flat footedness
ligament laxity, idiopathic, familial, tibialis posterior tendon dysfunction
37
what is a cause of rigid flat footedness
tarsal coalition
38
true/false - the first toe is most affected by overlapping of toes
false - fifth is
39
what is DDH, what hip is it more common in and who is more likely to get it
dilocation/subluxation of the femoral head affecting further development of the hip more common in the left hip and women
40
risk factors for DDH
FHx Breech position first born other congenital disorders and downs syndrome
41
untreated pathology of DDH?
acetabulum formed is shallow so false acetabulum may form proximal to original severe OA may occur due to lesser SA
42
what is barlow's test
dislocatable hip with flexion and posterior displacement
43
what is ortolani test
reduced dislocated hip with abduction and anterior displacement
44
true/false - DDH can be detected in a 3 month old by radiograph
false - USS should be used for up to 4-6 months as the head of femur is not ossified
45
what is transient synovitis of the hip
self limiting inflammation of hip joint following viral URTI (or other) most common paeds hip pain and usually boys age 2-10
46
what is perthes disease, who gets it
idiopathic osteochondritis of fem head, transient lost blood supply so altered growth and possible collapse and OA boys aged 4-9, short and active
47
what is SUFE, whos more likely to get it
slipped upper femoral epiphysis, overweight prepubescent boys, hypothyroidism and renal disease
48
a child has knee pain, what joint do you examine?
the hip, never forget it as it follows referred pain from obturator nerve
49
what is apophysitis
inflamation of a growing tubercle where a tendon attaches
50
what is osgood-schlatter disease
apophysitis of tibial tubercle
51
what is sinding-larsen-johnasen disease
apophysitis of inferior pole of patella
52
what is osteochondritis dissecans and where is it most common
hyaline cartilage breaks off joint surface, knee
53
what is talipes equinovarus and what deformity does it cause
abnormal in uero alignment of joints between talus, calcaneus and navicular ankle equinus, forefoot supination and varus alignment
54
who is talipes equinovarus more common in
oligohydraminos and breech presentation, twice as common in males
55
red flags for paediatric leg pain?
``` asymmetry good localisation short hx persisitent limp fail to thrive worsening pain tender and guarding reduced ROM ```
56
what is a salter harris I fracture and what prognosis does it carry
pure physeal seperation | best prognosis and least likely for growth arrest
57
what is a salter harris II fracture and what prognosis does it carry
mostly physeal frcture most common and small metaphyseal fracture attached to epiphysis and metaphysis low likelihood growth disturbance
58
what is a salter harris III/IV fracture and what prognosis does it carry
intra articular fracture with splitting of physis so greater risk growth arrest reduce and stabilise to ensure congruent joint surface - this minimises post traumatic OA and growth arrest
59
what is a salter harris V fracture and what prognosis does it carry
compression to physis with subsequent growth arrest | not disgnostic on xray and only once angular deformity has occurred
60
features of NAI
``` poverty, special needs, substance abuse bruising/injury of different age multiple trips to A&E inconsistent or changing injury discrepancy in hx with parents/carers injury not consistent with child age dental injury, LL and trunk burn, torn frenulum, genital injury and cigarette burns rib fracture metaphyseal fracture in the young infant ```
61
how is a distal radius buckle fracture managed
splint for 3-4 weeks as stable
62
how is a distal radius greenstick fracture managed
manipulation if angulated and casting if there is deformity
63
what salter harris fracture is common in fracture to distal radius and how is it managed
manipulate to correct angulation/deformity casting salter harris II - low risk growth arrest
64
in a complete childrens distal radius fracture, how is it managed and what displacement/angulation is most common
dorsal displacement/angulation if stable then cast unstable - wires or plate fixation
65
how would you manage a childrens monteggia and galeazzi fracture
plates and screws with rigid anatomical fixation
66
how would you manage a fracture of both bones of forearm
if there is one plane of angulation then casting may be okay displaced fractures are unstable so flexible IM nail is often used
67
types of fracture to supracondyle of elbow
extension type most common due to fall on outstretched hand | flexor type can occur due to fall on point of elbow
68
managing undisplaced supracondylar elbow fracture
splint as stable
69
managing an angulated, rotated or displaced elbow fracture
closed reduction with wire pinning manage quickly to avoid swelling if severely displaced brachialis may be tethered and needs open reduction if radial pulse absent emergency surgery to reduce/explore
70
why cant people with off ended extension fracture of elbow supracondyle make an OK sign
distal fragment displaces posterior to stretch and put pressure on brachial artey and median nerve loss of FPL and FDP
71
how should nerve injury on supracondylar elbow fractures be managed
manage urgently in theatre majority are neuropraxia but can be axonotmesis neuralgic pain ongoing may be entrapment needing surgical release
72
how may a childrens femoral shaft fracture ccur
flexed knee, indirect bending/rotation
73
why can shortening in femoral fractures be tolerated
there is usually overgrowth
74
true/false - in <2y 1/4 fem shaft fractures are NAI
false - 1/2 are
75
how is femoral shaft fracture in <2 managed
gallows traction and hip spica cast
76
how is femoral shaft fracture in 2-6 managed
thomas' splint or hip spica cast
77
how is femoral shaft fracture in 6-12 managed
flexible IM nail
78
how is femoral shaft fracture in >12 managed
Adult IM nail
79
if there is no obvious hx for femur shaft bone fracture what may it be
NAI | benign/malignant bone tumours
80
true/false - the risk of compartment syndrome during a paeds tibial fracture is more than that of an adult
false - it is less
81
how much angulation is tolerated in paeds tibial fracture
10 degrees, above that manupulation and casting needed
82
true/false - shortening and rotation can be accepted in tibial fracture
false - never
83
why are serial x rays important in a tibial fracture
ensure there is no angulation drifting in AP/lat
84
when would you offer casting for a tibial fracture in children
undisplaced spiral fracture, usually in toddlers | stable fractures that have little to no angulation or are manipulated
85
how would you stabilise an unstable/open tibial fracture in children
flexible IM nail or in closed prox tibial physis an adult one plates and screws external fixator

MB2 Rheumatology and Orthopaedics (22 decks)

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