Scoliosis

Idiopathic scoliosis [Ref- Sing Med J. 1988; 29:219-221; Maheshwari Orthopedics 3/e p235]

• Risser’s Localiser cast is used for non-operative correction of idiopathic scoliosis. Other casts and braces used for scoliosis are: Milwaukee brace, Boston brace
• Operative management of idiopathic scoliosis includes:

1. The Harrington Rodding
2. Rod and sublaminar wiring (Luque)
3. The Cotrel-Dubousset system

d.Anterior instrumentation (Dwyer; Zielke)

Casts and Splints

Minerva cast———————————— Cervical spine fracture

Hanging cast———————————— Fracture Humerus

Cylinder cast———————————– Fracture Patella

Patellar tendon bearing cast————— Fracture Tibia

Aluminium splint—————————– immobilization of finger

Thomas splint———————————- Fracture femur

Bohler Braun splint————————– Fracture femur

Toe rising splint——————————- Foot drop

Knuckle bender splint———————– Ulnar nerve palsy

Cock up splint——————————— Radial nerve palsy

Dennis Brown splint————————- CTEV

• Also Know

Risser’s sign:

This is a sign to assess skeletal maturity as the scoliotic curvature progresses most during the period of rapid skeletal growth.

The iliac apophyses start ossifying shortly after puberty. Once the iliac crests are completely ossified, further progression of the scoliosis is minimal (Risser’s sign)

Block vertebra type of scoliosis has the best prognosis. The progression is slow and it can be corrected easily, whereas unilateral thoracic unsegmented type carries worst prognosis.

Ref: Orthopaedic Surgery Essentials in Pediatrics By Kathryn E. Cramer, Susan A. Scherl, 2004), Page 65; Campbell’s Orthopaedics, 11th Edition, Page 2607.

Ans. is ‘a’ i.e., Spastic quadriplegia

“Scoliosis is common, occuring in 15 to 25 percent of the total body CP (spastic quadriplegia CP)”. — Tachdjian Cerebral palsy (CP)

o Cerebral palsy is defined as a non progressive neuromotor disorder of cerebral origin.

o It has following features ‑

i)      Static (nonprogressive)

ii)     Disorder of movement/motor disorder (but sometimes sensory involvement may occur)

iii)    Cerebral in origin

Etiopathogenesis

o CP is due to an insult of developing brain.

o The insult results in maldevelopment and disorderly anatomic organization of the brain.

o The insult may be prenatal (most of the cases), during delivery or in the postnatal period.

Classification

o CP may be classified into following types –

1) Spastic cerebral palsy                              

2) Hypotonic (Atonic) CP

3) Extrapyramidal CP

4) Mixed type CP

•  This is the most common type
•  This includes        

i) Spastic quadriparesis  ii) Spastic diplesia         iii) Spastic hemiplegia

Ans. is `d’ i.e., All 

Answer is A (Reduced RV and TLC):

Kyphoscoliosis is a restrictive lung disease.

• There is decrease in residual volume and total lung capacity.
• FEV1 and FVC are proportionately decreased.
• Hence the ratio of FEV1 to FVC remains normal or is increased.
• The forced expiratory flow rate (FEF) is normal.
• Functional residual capacity (FRC) is decreased.

Ans. C.)Scoliosis.

Causes of Unilateral Elevation of Diaphragm:

Unilateral elevation of Diaphragm occurs more commonly in left side as compared to right side.

Also,the most common cause is acquired Phrenic nerve palsy.

So,looking to the above discussion,Scoliosis may be the correct answer.

Ans. is ‘a’ i.e., Forward bending

The forward bending test is very sensitive in demonstrating the vertebral rotation that takes place in a structural scoliotic curve.

• Quantification of the rotation is done by measuring the rib hump by use of inclinometer or scoliometer.
• Severity of the curve in scoliosis is measured by cobb’s angle, i.e. an angle between line passing through the margins of vertebra at ends of curve. To use the cobb method, one must first decide which vertebrae are the end-vertebrae of the curve. These end vertebrae are the vertebrae at the upper and lower limits of curve which tilt most severely toward the conavity of the curve. Other method used to measure scoliosis angle is Ferguson’s method.

Ans. is ‘a’ i.e., Scoliosis

The Milwaukee brace is principally a thoracic support consisting of a pelvic corset connected by adjustable steel supports to a cervical ring carrying occipital and chin pads.

Its purpose is to reduce the lumbar lordosis and encourage active stretching and straightening of the thoracic spine.

It is used in the conservative management of idiopathic scoliosis.

Ans. is ‘c’ i.e., Scoliosis.

Minerva cast                               Cervical spine disease

Risser’s cast                               Scoliosis

Turn-buckle cast                         Scoliosis

Shoulder spica                            Shoulder immobilisation

U-slab                                       Fracture of the humerus

Hanging cast                              Fracture of the humerus

Colle’s cast                                Colles’ fracture

Hip spica                                   Fracture of the femur

Cylinder cast                              Fracture of the patella

PTB cast                                    Fracture of the tibia