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MSK > Children's orthopedics > Flashcards

Children's orthopedics Flashcards

1
Q

What three classes of congenital diseases do we need to know?

A

Skeletal
Muscular dystrophies
Connective tissue disorders

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2
Q

What are the two congenital skeletal diseases we need to know?

A 
Osteogenesis imperfecta (Brittle Bone Disease)
Skeletal dysplasia
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3
Q

What is osteogenesis imperfecta?

A

Autosomal dominant defect in type 1 collagen leading to brittle bones.

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4
Q

How does osteogenesis present?

A

Multiple fractures (low energy), short stature, deformities, blue sclera, loss of hearing, can be fatal.

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5
Q

How do you treat osteogenesis imperfecta?

A

Treat fractures with splint, traction and stabilization.

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6
Q

What is skeletal dysplasia?

A

Short stature. Do NOT use ‘Dwarfism’!!!

Abnormal development of bone and connective tissue that can be proportional is disproportional.

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7
Q

What is the most common form of skeletal dysplasia?

A

Achondroplasia- Short limbs and large nose and forehead.

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8
Q

How do you treat skeletal dysplasia?

A

Treat deformities and can give growth hormone therapy.

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9
Q

What are the two muscular dystrophies we need to know?

A

Duchenne Muscular Dystrophy

Becker’s Muscular Dystrophy

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10
Q

Describe the genetics of muscular dystrophies.

A

Rare
X-linked
Recessive

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11
Q

What causes Duchenne Muscular Dystrophy?

A

Ca2+ transporter deformation resulting in muscle weakening.

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12
Q

How does Duchenne Muscular Dystrophy present?

A

Difficulty standing at young age
Can’t walk by 10
Cardiac and resp failure in 20s

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13
Q

How do you diagnose Duchenne Muscular Dystrophy?

A

Raised serum creatinine phosphokinase and muscle biopsy.

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14
Q

How can you treat Duchenne Muscular Dystrophy?

A

Physio, splint and correction can prolong mobility

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15
Q

What is Becker’s Muscular Dystrophy?

A

Similar to DMD except milder and has a teenage onset.

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16
Q

What are the three connective tissue disorders we need to know?

A

Generalised Joint Laxity (Double Jointedness)
Marfan’s Syndrome
Ehlers-Danlos Syndrome

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17
Q

What is generalised joint laxity?

A

Double jointedness

Autosomal dominant condition found in ~5% of people.

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18
Q

What are the problems with generalised joint laxity?

A

More prone to soft tissue injury and dislocations.

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19
Q

What is Marfan’s syndrome?

A

Autosomal dominant condition resulting in a tall person with disproportionately long limbs.

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20
Q

What complications are associated with Marfan’s syndrome?

A 
Lax ligaments
High palate
Sclerosi and pectus excavatum 
Eye problems
Aortic aneurysm and valve problems
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21
Q

What is Ehlers-Danlos syndrome?

A

An autosomal dominant disease resulting in abnormal elastin and collagen.

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22
Q

What are some of the complications of Ehlers_Danlos syndrome?

A

Joint hypermobility

Easy bruising

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23
Q

What are the only two recessive congenital diseases we need to know?

A

Duchenne Muscular Dystrophy

Becker’s Muscular Dystrophy

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24
Q

What are the three neuromuscular diseases we need to know?

A

Cerebral Palsy
Spina Bifida
Polio

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25
Q

What is polio?

A

Viral infection of the anterior horn affecting LMNs.

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26
Q

What are the symptoms of polio?

A

Flu like symptoms in initial infection.
Paralysis of muscle group 2-3 days later
Some LMN recover with weakness and some don’t

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27
Q

What problems does polio cause?

A

Joint deformities and growth defects.

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28
Q

How are the complications of polio treated?

A

Splint, risers on shoe, tendon transfer, joint fusion and lengthening/shortening.

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29
Q

What is spina bifida?

A

Herniation of part of the spinal column due to the two parts of the posterior vertebral arch failing to fuse.

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30
Q

What are the two subdivisions of spina bifida?

A

Spina bifida occulta- Mild form.

Spina bifida cystica- Severe form

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31
Q

Describe the problems associated with spina bifida occulta.

A

No problems but can get arched foot, clawed toes and dimple over the area.

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32
Q

Describe the two forms of spina bifida cystica.

A

Meningocele- Meninges alone herniate

Myelomeningocele- SC or CE herniate too

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33
Q

What are the problems associated with meningocele spina bifida cystica?

A

No problems

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34
Q

What are the problems associated with myelomeningocele spina bifida cystica?

A

Motor and sensory deficits

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35
Q

How do you treat spina bifida?

A

Close hole, correct scoliosis, release contractures and reduce/contain hip

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36
Q

What causes Cerebral Palsy?

A

Genetic problems, brain malformation, infection, prematurity, hypoxia or meningitis.

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37
Q

At what age does cerebral palsy occur?

A

2-3 YO

38
Q

How does cerebral palsy present?

A

Expression and severity depend on part of brain affected.

39
Q

What is the most common form of cerebral palsy?

A

Spastic CP (80%)- Affects motor cortex.

40
Q

What problems can cerebral palsy cause?

A

Joint contractures, scoliosis, hip dislocation.

41
Q

How do you treat the problems cerebral palsy causes?

A

Physio, splinting, botox, baclofen, surgical release of joints, correction of scoliosis.

42
Q

At how many weeks do limb buds start to form?

A

4-6

43
Q

What are the two types of developmental disorder we need to know?

A

Limb Malformation

Obstetric brachial Plexus Palsy

44
Q

Give some examples of what can go wrong in limb malformation.

A

Extra bone
Missing bone
Short bone
Fused bone/skin/soft tissue

45
Q

Give 4 examples of limb malformation.

A

Syndactyly
Polydactyly
Fibular hemimelia
Congenital fusion

46
Q

What is syndactyly?

A

2+ digits fuse either fully or partially. Can be surgically separated.

47
Q

What is polydactyly?

A

An extra digit. Can be amputated.

48
Q

What is fibular hemimelia?

A

Partial or complete loss of fibula. SHortened leg, bowed tibia and ankle deformity.

49
Q

How do you treat fibular hemimelia?

A

Mild- Lengthen leg

Severe- Amputate

50
Q

What is congenital fusion?

A

Most common between tarsal bones- can lead to sore flat feet.

51
Q

What is obstetric brachial plexus palsy?

A

Damage to the brachial plexus during birth.

52
Q

What are the two forms of obstetric brachial plexus palsy?

A

Erb’s palsy

Klumpke’s palsy

53
Q

Describe Erb’s palsy

A

Damage to C5+6. Internally rotated arm. Treat with physio and potential to operate.

54
Q

Describe Klumpke’s palsy

A

C8+T1 damage. Paralysis of intrinsic hand muscles, fingers and wrist. Fingers flexed.
No treatment and <50% resolve.

55
Q

What are the 5 MSK developmental landmarks in children?

A 
6-9m: Sits alone and crawls
8-12m: Stands
14-17m: Walks
24m: Jumps
3y: Climbs stairs unaided
56
Q

What are the 7 neurological developmental landmarks in children?

A 
1-6m: Loss of primitive reflexes.
2m: Head control
9-12m: Speaking a few words
14m: Eats w/ spoon
18m: Stacks blocks
18-20m: Understands 200 words
2-3y: Potty trained
57
Q

Describe the normal changes in knee alignment as a child develops

A

Varus at birth
Neutral at 14m
10-15 degree valgus at 3y
6 degree valgus at 7-9y

58
Q

What is genu varum?

A

Bow legged

59
Q

What can cause genu varum?

A 
Blount's disease- Excessive medial growth
Rickets
Tumour
Trauma
Skeletal dysplasia
60
Q

What is genu valgum?

A

Knock knee

61
Q

What can cause genu valgum?

A 
Rickets
Tumour
Trauma
Neurofibromatosis
Idiopathic
62
Q

What is in-toeing?

A

Feet point to midline.

Exaggerated on running/ look clumsy

63
Q

What can cause intoeing?

A

Internal tibial torsion- Normal

Forefoot adduction- Potentially need surgery

64
Q

What are the two types of flat feet?

A

Mobile- Arch appears on great toe flexion. Do nothing

FIxed- May require surgery

65
Q

What are the four knee pathologies we need to know?

A

Extensor mechanism problems
Patellar instability
Osteochondritis dissecans
Meniscal tears

66
Q

Name some knee extensor mechanism problems

A

Pain from growing in teens
Patellar tendonitis- Self limiting
Apophysitis- Inflammation of growing tubercle

67
Q

Name to apophysitis associated with the knee

A

Osgood-Schlatter- Inflammation of tibial tubercle

Sinding-Larsen-Johansson disease- Inflammation of patellar.

68
Q

What is patellar instability?

A

Dislocation or subluxation. Can be due to tear in medial patellofemoral ligament and anatomical variation.

69
Q

What is osteochondritis dissecans?

A

When knee dislocates part of hyaline cartilage can break off joint surface. Medial femoral condyle most common.
Poorly localised pain. effusion and locking
Predisposes to OA.

70
Q

What are meniscal tears?

A

Tears in the minisci.

Peripheral/bucket handle most common.

71
Q

What are the four pathologies of the hip we need to know?

A

Developmental dysplasia of the hip
Transient synovitis of hip
Perthes Disease
Slipped Upper Femoral Epiphysis

72
Q

What is developmental dysplasia of the hip?

A

Dislocated/subluxed hip during perinatal period which affects development.
Examine all hips at birth and diagnose early.

73
Q

How do you treat developmental dysplasia of the hip?

A

Pavlik harness for 6w full time then 6w at night.

74
Q

What is transient synovitis of the hip?

A

A synovitis in the hip most commonly after a respiratory infection. Most common cause of pediatric hip pain.

75
Q

What is Perthes disease?

A

Idiopathic osteochondritis of femoral head due to transient loss of blood supply.
Pain and limp. Can lead to OA.

76
Q

What is a Slipped Upper Femoral Epiphysis?

A

Femoral head epiphysis slips inferiorly to neck.
Common in overweight kids.
Groin and kneed pain. Loss of internal rotation.

77
Q

What does SUFE stand for?

A

Slipped Upper Femoral Epiphysis. Ice cream cone on XR.

78
Q

What are the two foot pathologies we need to know?

A 
Talipes Equinovarus (clubfoot)
Tarsal Coalition
79
Q

What is talipes equinovarus?

A

Clubfoot. Abnormal alignment of talus, calcaneus and navicular joints.
Splint.

80
Q

What is Tarsal Coalition?

A

Abnormal bony/cartilage/fibrous bridge between calcaneus and talus. Leads to flat foot.
Splint and can under go surgery.

81
Q

What are the two back pathologies we need to know about?

A

Scoliosis

Spondylolisthesis

82
Q

What is scoliosis?

A

Lateral curve in spine.

83
Q

What can cause scoliosis?

A 
Idiopathic
Neuromuscular disease
Tumour
Skeletal dysplasia
Infection
84
Q

How do you treat mild scoliosis?

A

No treatment

85
Q

How do you treat severe scoliosis?

A

Surgery. Severe can result in breathing problems.

86
Q

What is spondylolisthesis?

A

Slippage of one vertebrae over another.

Usually at L4/5 or L5/S1 level

87
Q

What can cause spondylolisthesis?

A

Developmental defect or recurrent stress fracture.

Linked to increased body weight and activity.

88
Q

How do spondylolisthesis present?

A

Lower back pain
Nerve impingement
Flat back due to spasm
Waddling gait

89
Q

How do you treat spondylolisthesis?

A

Mild- Rest and physio

Severe- Stabilization and reduction

90
Q

What is a gibbus?

A

Angular deformity of the spine in the sagittal plane.

MSK (17 decks)

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