Bone and joint infections of children Flashcards
How might a child with flat foot present?
Feet will be visibly flat - arches have not developed
ankles appear to turn inwards - weight bearing through inside of sole
How is flat foot treated?
Orthotics (insoles etc) or surgery
What might toe walking be a sign of?
Cerebral palsy
Duchenne MD
Other nervous system problems
How is toe walking in otherwise healthy children treated?
- casting foot and ankle for about 6 weeks to help stretch calf muscle
- physiotherapy
- surgery to release tight calf muscles
How does clubfoot present?
Also called talipes equinovarus
fixed varus and equinus deformity
- internal rotation of foot and contraction of achilles tendon
What are the risk factors for clubfoot?
breech presentation connective tissue disorder (ehlers danlos) oligohydramnios edward's syndrome (trisomy 18) family history
How is clubfoot treated?
Ponseti method - its like invisalign for your ankles –> stretching the ligaments/tendons/joints capsules and setting in a cast after each stretching
gradually reaching the correct alignment
What are the risk factors for congenital hip dysplasia?
female breech presentation 1st born family history oligohydramnios
(associated with scoliosis and clubfoot)
How is congenital hip dysplasia diagnosed?
Ortolani: relocating subluxed hip Barlow: dislocating hip Galeazzi: later diagnosis + limb length discrepancy Ultrasound Radiography
Explain Graf grading of congenital hip dysplasia.
Use US to measure the alpha angle - this is the angle between the hip joint inclination and the iliac margin normal angle will be >60 Grade I: >60 Grade II a,b: 50-59 Grade IIc: 43-49 Grade IIIa,b, IV: <43
How can radiographs be used to diagnose congenital hip dysplasia?
Limited use until femoral ossifies around 4-6 months
Look at the angle between Hilgenreiner’s line and acetabular index line, should not be >34 degrees
Also use Perkin’s line - femora head should be in the lower median quadrant
How is congenital hip dysplasia treated?
Usually corrects spontaneously within 2-8 weeks
<6 months: closed reduction + immobilisation with Pavlik harness (6 weeks full time + 6 weeks part-time)
>6 months: closed reduction with spica cast
>18 months: open reduction
What is Perthe’s disease and what is the epidemiology?
Self-limiting avascular necrosis to the femoral head
1:1000
4:1 males
usually unilateral
What are the different stages of Perthe’s disease?
- Necrosis: portion of femoral head dies and shapes changes causing pain, stiffness and inflammation –> up to 1 year
- Fragmentation: dead cells absorbed + replaced by new bone cells. Varying femoral head shapes –> 1-3 years
- Reossification: femoral head continues to grow with new bone cells –> 1-3 years
- Remodelling: New bone cells are gradually replaced by normal bone cells and remodelling continues –> 1-3+ years
How is Perthe’s disease treated in young children and older children?
<5 years/mild cases:
- observation
- physiotherapy
- bed rest
- plaster cast or braces
- abduction to keep femoral head in acetabulum
Older children:
- surgery –> osteotomy
What is SUFE? What are the potential causes?
SUFE = Slipped Under Femoral Epiphysis
Due to obesity, hypothyroidism, deficiency or increased androgens, trauma
What are the different types of SUFE?
Pre-slip: wide epiphyseal line, no slippage
Acute: slippage sudden
Acute-on-chronic: slipping occurs acutely on existing chronic slip
Chronic: steady progressive slippage (more common)
What is klein’s line? What is its association with SUFE?
Virtual line that can be drawn on an x-ray of an adolescents hip parallel to the upper edge of the femoral neck
if the line does not intersect the outermost part of the femoral head then a diagnosis of SUFE can be made
How is SUFE treated? What complication can arise in unilateral fixation?
Rest
Analgesia
Surgery (closure of growth plate via screws, may be followed by corrective osteotomy)
Unilateral fixation of SUFE can lead to contralateral slip
What is Blount’s disease?
Growth problem of the distal tibia (medial compartment)
Causes tibia varus
Medial part of proximal tibia fails to develop = angulation –> this is an irreversible pathological change
How is Blount’s disease treated?
Conservative: braces
Surgical: if early onset of brace fails
- can perform osteotomy and gradual distraction
What is Osgood-Schlatter’s? What are the potential causes? How does it present?
Osteochondrosis –> disturbance of endochondral ossification
Self-limiting –> symptoms disappear ~1 year after onset
Cause: repeated traction from the patellar ligament on the tibial tuberosity
- avulsion fractures to parts of the tibial tuberosity
presents with pain the point of insertion of patellar ligaments
How is Osgood-Schlatter’s treated?
rest
avoidance of activities causing pain
NSAIDs
strapping + brace to support knee
