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Paediatric Musculoskeletal Conditions Notes

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This is an extract of our Paediatric Musculoskeletal Conditions document, which we sell as part of our Orthopaedics Notes collection written by the top tier of University Of Leicester students.

The following is a more accessble plain text extract of the PDF sample above, taken from our Orthopaedics Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Paediatric Musculoskeletal Conditions Talipes Equinavarus (Club Foot) Inversion of the foot Adduction of the forefoot relative to the hindfoot Plantar flexion Males> Females Increased risk if 1st degree relative affected Two main types Positional
? Postural equinovarus o Normal foot held in abnormal position in utero e.g due to oligohydramnios Fixed
? Congenital (associated with cerebral palsy and spina bifida)
? Teratogenic o Also strong association with maternal smoking Clinical features
- Affected foot may be smaller than other foot
- Lateral aspect of sole of foot may be keratinized
- Calf muscles appear atrophied
- If foot looks abnormal whilst lying, scratch the side of the foot. A normal foot will evert, dorsiflex and toes fan Investigations
- AP and lateral views on xray - standing
- USS Management
- If positional, deformity can be corrected with passive dorsiflexion
- Otherwise o Conservative
? Series of plaster casts (ponseti regime) o Surgical intervention
? Loosen muscles if necessary o Denis Browne boots used to maintain correct position of foot

Developmental Dysplasia of the hip (DDH) Compromised a spectrum of disorders including;
- Frank dislocation
- Subluxation
- Unusually shallow acetabulum without actual displacement Aetiology
- Positive family history
- Breech position at birth
- Female
- First born child
- Multiple developmental abnormalities (spina bifida, club foot etc)
- Restricted perinatal movement e.g oligohydramnios Pathogenesis
- Shallow acetabulum
- Femoral neck unduly anteverted Clinical features
- Delayed walking
- Limp
- Asymmetrical skin creases
- Decreased abduction
- Leg short and externally rotated DDH checked for shortly after birth + at 6 weeks Barlow's Sign
- Stabilise pelvis
- Move thighs into mid abduction
- If hip unstable, backward pressure on lesser trochanter causes femoral head to slip out of acetabulum Ortolani's test
- Flex hip and knees to 90
- Abduct hips gently applying forward pressure to each femoral head
- Positive sign = palpable sensation of femoral head slipping into acetabulum Investigations
- USS if < 3-4 months as cartilaginous sutures don't show up on xray well
- Xray if > 3 months Management
< 6 months old - conservative treatment with harness to hold hip in flexion and abduction
? 6 months old - surgical reduction o Complications include
? Redislocation
? Stiffness
? Blood loss

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