W13 - Complex Needs, CP, Scoliosis, Talipes; EMERGENCIES, Fractures, NAI Flashcards
Definition of scoliosis and the normal sagittal alignment of the spine
deviation in coronal plane is a scoliosis
cervical lordosis
thoracic kyphosis
lumbar lordosis
sacral kyphosis
Understand spinal and non-spinal causes of scoliosis
non-structural = dt extrinsic cause, resolves when factor adressed e.g hip problem, leg length
structural scoliosis = abn rotation of vert.; propensity to progress
Classification of Scoliosis + At Risk
CONGENITAL: abn of vertebral formation
IDIOPATHIC:
- infantile
- juvenile
- adolescent
NEUROMUSCULAR
OTHER:
- post traumatic
- degenerative
- infective
- syndromic
*Area of primary site
At risk:
* neuromusc causes = Cerebral Palsy, Muscular Dystrophy = high risk of progression
Understand basics of investigation, and conservative and surgical management of children with scoliosis
- XR: AP
- MRI = cord abn, vertebral abn., tumours
> BRACING > Sx: COMPLEX & extensive * nerve root dmg, cord traction * vascular injury * degenerative changes later * rods * crankshaft phenomenon
Define features of TEV and be familiar with Ponseti method of treating
Congenital Talipes Equinovarus - Club Feet
- common deformity; M>F
- risk for 2nd child slighlty increases
- MULTIFACTORIAL
*Dx: USS
• Cavus; Adductus; Varus; Equinus
> specific technique of manipulation of the clubfoot deformity, followed by the application of a plaster cast with the foot in the corrected position.
- multiple casts
- equinus corrected = percutaneous tenotomy of achilles tendon
Be aware of main cause of relapse and need for continued splintage
a
Define cerebral pals and be familiar with pre, peri and postnatal causes
A permanent and non-progressive motor disorder due to brain damage before birth or during the first 2 years of life; accounts for a proportion of children with complex needs
PRENATAL
- placental insufficiency
- toxaemia
- smoking, alcohol drugs, infection: toxoplasmosis, rubella, CMV etc.
PERINATAL
- prematurity
- anoxic injuries
- infection; kernicterus (xs bilirubin); haemolytic disease of new born
POSTNATAL
- infection
- head trauma
- DYNAMIC CONTRACTURES
- FIXED MUSCLE CONTRACTURES
- JOINT SUBLUXATION/DISLOCATION
Classification of Cerebral Palsy
—-PHYSIOLOGICAL
SPASTIC: pyramidal system, motor cortex
ATHETOID: extrapyramidal system, basal ganglia
ATAXIA: cerebellum, brainstem
MIXED
—–ANATOMICAL
MONOPLEGIA = one limb
HEMIPLEGIA = one side
DIPLEGIA = lower limb
QUADRIPLEGIA or total body involvement
-----GROSS MOTOR FUNCTION CLASSIFICATION I - walk w/o limitations II - w/ limitations III - hand-held mobility device IV - self mobility w/ limitations V - manual wheelchair * higher level = higher risk of hip dislocation
Know main MSK goals in children with CP. Be aware of reasons for and methods of treatment of hip dislocation in CP. Familiar with at risk groups.
- prioritise: spine, hip, feet, torsional problems, upper limb function
- sitting balance, standing posture
- optimise gait = assessment by obs, video, 3d instrumented analysis +/-EMG
*Dislocated hips = pain, upsets sitting posture
* Higher the level of gross motor function classification = higher risk of hip dislocation
> early sx intervention = better outcome
> Posture mgmt: physio, seating > Spastic mgmt - Diazepam - Botulinum toxin - Baclofen oral / intrathecal pump > Deformity mgmt: soft tissue release; bony realignment
sx = better prognosis but not all at risk of dislocation and is a significant surgery
Phases of Gait
STANCE
1) Initial Contact
2) Loading Response
3) Mid Stance
4) Terminal Stance
5) Pre-Swing
SWING
1) Initial Swing
2) Mid Swing
3) Terminal Swing
Significance of early dx in Scoliosis
- ID and manage severe curves dt poorer outcomes:
cardioresp; pain; seating issues; sx challenge - neuromuscular causes are at high risk of progression
Four types of paediatric fracture and implications of these
- COMPLETE #
- GREENSTICK #
re-displace
> bent cast
- BUCKLE (TORUS)
dt longitudinal compression
*inherently stable #
> simple splintage
- PLASTIC DEFORMITY
common in forearm, sequence of cracks = bending of bone; cannot return to normal arrangement.
*increased risk of dislocation
NIL REMODELLING dt minimal dmg
Describe the different types of growth plate fractures according to the Salter-Harris classification and broadly have an understanding of growth disturbance
Physeal # = physis weaker than ligaments; growth arrest risk
= progressive deformity
SH1 = parallel/goes along growth plate SH2 = starts going along and angles into metaphysis (COMMONEST)
SH3 = right angle to growth plate
> reduction and fixation if DISPLACED
SH4 = # growth across growth plate obliquely
* associated with ankles
=> SH3 and SH4greater risk of growth disturbance
SH5 = compression of growth plate (longitudinal)
Common sites of injury and suspicious features of non-accidental injury
Non Accidental Injury; sign of neglect
*delay in presentation # pattern not fit mechanism * bruising, burns * metaphyseal #, humeral shaft # * Rib # *# at different stages of healing = PATHOGNOMIC
•50% recurrence
> Social work department involvement
Understand why paediatric fractures are usually treated conservatively
• Quickly heal w/ good blood supply
• Nature of injury often low velocity trauma
• Remodelling rate is inverse to age; oppositional periosteal growth and opposition
+ differential physeal growth
* Remodelling in plane of joint movement >Cast > Braces > Splints > Traction
> Immobilise pain, remove cast/splint when healed
Open # = Debridement
