paediatric orthopaedic conditions Flashcards
(46 cards)
what is congenital talipes equino varus?
-also called clubfoot
-a congenital defect when both of your feet are rotated inwards and downwards
are males or females more likely to experience club foot?
males are more likely
what does the management of club foot involve?
-to obtain a straight, painless, plantigrade and mobile foot
what is the ponseti method?
- a conservative and manipulative method to treat club foot
-involves mobilisation to correct the position and serial casting and tenotomy of the achilles tendon to maintain a corrected position
what is a tenotomy?
a procedure which involves inserting needles into the damaged parts of the tendon
-done to improve movement and correct deformities
what is the role of physio for babies with club foot?
-may have role in correction of deformity during serial casting - may be done by doc, nurse or physio
-restore ROM post casting / surgery
-restore strength post casting and surgery
-gait education
what is developmental dysplasia of the hip (DDH)?
- this is a problem with the way a baby’s hip joint develops - the head of the femur dosent fit into the acetabulum
what are the 3 types of DDH?
classified by the severity of the hip joint instability and dislocation
1. dislocated hip ie the hip joint is out of the acetabulum
2. subluxation - head of femur is partially shifted out of the acetabulum
3. dislocatable- the head of femur moves out/ can dislocate with movement
what are examples of unilateral signs of DDH?
-decreased abduction in the hip
-asymmetrical skin creases
-apparent shortness of 1 leg
-trendelenburg gait
-antalgic gait
what are examples of bilateral symptoms of DDH?
-wide perineum
-wide pelvis
-increased lumbar lordosis
-waddling gait
-trendelenburg
-symmetrical limited abduction
what is the aim of the management of DDH
-aim is to maintain the hip in abduction to encourage the hip capsule to tighten
what’s the difference between the conservative vs surgical management of DDH?
-conservative - manipulation under anaesthetic and can use splints for up to 3-6 months
-if conservative management fails (usually detected at an older age), followed by a period in hip spica
what is the role of physio during the splinting stage of DDH?
- advice to parents on skin care/splint care
-advice to parents on lifting / handling
-promoting normal development
-gait training
what does the role of physio involve post-operatively in DDH?
-ROM
-muscle strengthening
-hydrotherapy
-gait training
what is perthes disease?
- a condition that affects the head of the femur
-the blood supply decreases to the head of femur and leads to osteochrondritis or osteonecrosis of head of femur
what is osteochrondritis?
piece of cartilage, along with a thin layer of the underlying bone, begins to separate from the surrounding bone due to a lack of blood flow
are males or females more likely to experience perthes disease?
-males are more likely than females
what are the stages of perthes?
-condensation
-fragmentation
-reossification
-remodelling
describe condensation as a stage
when the blood supply is smaller or absent - whiter head on xray & hip joint is painful and stiff
describe fragmentation as a stage
-necrotic bone is resorbed and fragmented
-the femoral head becomes derformed ad the acetabulum flattens
describe reossification as a stage
-return of blood supply
-femoral head begins to re-ossify
describe remodelling as a stage
-when the femoral head remodels
what are examples of clinical features of perthes disease?
-pain
-limp
-decreased ROM - abduction and medial rotation
-collapse head of femur
-limb shortening
what can be seen on xray with perthes disease?
X ray
-widening joint space
-short femoral neck
-fragmentation of femoral head
