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Orthopaedics - Coggle Diagram

- - - - Most common 80%
    - - Result of abnormality in formation or segmentation of the vertebrae
    - - Caused by cerebral palsy, spina bifida, muscular dystrophies, spinal cord injuries
    - - Poor posture / Unequal leg length
  - - - Concerns
        
        Spinal deformity
        
        Spinal dysfunction
        
        Respiratory dysfunction
        
        Death
        
        Physical / emotional dysfunction ?
      - Treatment
        
        Simple EOS - Growing Rods
        
        MIS technique
        
        Screws vs hooks
        
        Single vs dual
        
        Interval lengthening
        
        Diminishing returns
        
        Body cast
        
        Bracing
    - - More common in females
  - - - Shoulder heights
      - Hips or waist / flank fullness
      - Prominence of shoulder blade
      - One leg appears longer than the other
      - Breast anterior chest wall
      - Chest or rib prominence
  - - - Failure of segmentation (seperation) of vertebrae
      - Failure of formation of vertebrae
      - Combination
    - - Early surgery if indicated
  - - - Disorders of brain, spinal cord, muscular system
    - - Curves tend to rapidly progress
      - May progress after skeletal maturity
      - Long and involve more of the spine
    - - Higher rate of pulmonary complications
      - 25-40%
    - - Surgery if indicated
- - - - Increased external rotation with hip flexion
      - Resists internal rotation and extension
    - - AP and lateral
      - Disruption of Klein's line
- - - - Toricollis
      - Metatarsus adduction
  - - - Barlow / Ortolani tess
        only reliable in neonatal period
    - - Very sensitive
      - One side compared to the other
    - - Compares length of femur by compairing level of 2 knees when brought together and hips flexed
      - Affected leg appears shorter
  - - - Ortolani / Barlow
      - Hip Abduction
      - Galeazzi sign
    - - US
        
        Best up to 3 months
      - AP pelvic film
        
        After 6 months
        
        Shenton's line broken and higher on affected side
      - Athrogram
        
        Inject dye into hip joint
        
        Required GA
        
        Allows assessment of stability
  - - - Frog leg position
      - Readjust every week as baby grows
    - - Indicated in inadequate cover of femoral head
- - - - Pt is not septic
      - Decreased range of motion
      - Effusion within hip os US
      - Kocher's Criteria usually not fulfilled
      - Hx of preceeding RTI or viremia
    - - Aspirate - If organisms found , wash out hip and commence ABX
      - NSAIDs
- - - - Exam spine in any child with foot problem
      - Hindfoot
        
        Fixed equinus
        
        Fixed varus
      - Midfoot
        
        Adductus
        
        Cavus (high arch)
      - Foot supination
    - - X-ray
        
        AP
        
        Forced dorsiflexion lateral
        
        Difficult to interpret - bones not ossified / calcified
  - - - Ponseti method
    - - Achilles tenotomy
      - Posteromedial release
- - - - Incomplete / Partial fractures
        
        Due to thick periosteuma nd porous cortex
      - Plastic deformity
        
        Bone bent out of shape then straighten back most of the way due to elastic recall
      - Fracture through Hypertrophic zone of physis
        
        CArtilage is stiffening and become more brittle as it calcified
  - - - Salter-Harris
      - Seperation purely through growth plate
        Across
      - Seperation of the physis but also taking a chunk of metaphysis
        Below
      - Fracture throught the growth plate effecting the epiphysis (into the joint)
        Above
      - Fracture affecting metaphysis, epiphysis and growth plate
        Through
      - 5 Crush injury to growth plate
        Compression
  - - - An incomplete fracture of the diaphysis of a long bone resulting in bulging of the cortex
      - Cast or splint
    - - Incomplete failure in tension
    - - Bending
      - Often need to break to reduce
  - - - Femur - lg length discrepancy
        Will correct overtime
    - - Physeal injury
      - Shortening or asymmetric shortening
  - - - Most common operative fracture
      - Peak at 7-8 yrs
    - - Nerve injury
      - Missed neurovascular injury - Major cause of litigation
    - - Pining
- - - - Young
      - 1st born
      - Premture
      - Disabled
      - Stepchildren
    - - Single parent home
      - Drug abusing parents
      - Low income
      - Children of parent who were abused
- - - - Management
        
        PRogressive - get in control early
        
        Riskier with progression
      - Complications
        
        Compression of spinal cord
    - - Accentuated by growth spurt
      - Wedge shaped vertebrae
      - Hamstring tension
  - - - Malformed vertebrae
    - - Disturbance of growth - anterior growth of bertebral column slows but accelerates posteriorly
  - - - Do not correct more than 50%
      - Risks of junctinoal deformit or failure of implants or both
        
        Higher rate in kyphosis surgery than scoliosis
- - - - Overall alignment
    - - Tibial torsion
    - - Femoral anteversion
  - - - Normal
      - Extenral rotation contracture
    - - Tibial torsion
      - Femoral tosion - less common