Bone and Joint Problems in Children Flashcards
What are the common bone/joint problems in children?
- flat foot
- club foot
- toe walking
- congenital dysplasia of the hip
- Perthe’s
- Blount’s disease
- Osgood-Schlatter
What is flat-foot?
- most babies born with it
- develop arches in growth
- top of foot more rounded
- flexed toes
- bottom flatter with slight medial arch and no lateral arch
- some arch never develops
- notice weak ankles
- turn ankles inwards
What is the treatment for flat foot?
- orthotics = mould as bones are soft so will easily grow into it
- surgery
What is toe walking?
- common in toddlers as they learn to walk
- habitual
- can shorten plantar flexors as get used to working at short length
- disappears by age of 2
What is the differential diagnosis of toe walking?
- cerebral palsy (hypertonia)
- DMD
- nervous system problems
What is the treatment of toe walking?
- cast foot/ankle for 6 weeks to stretch calf muscles
- physiotherapy
- surgery to release tight calf muscles
What is Club foot?
- fixed varus (inwards) and equinus deformity
- more males
What are the causes of club foot?
- constraint development problem (oligohydramnios or breech presentation)
- genetic syndromes (CT disorder, Edwards, family history)
What is the treatment for club foot?
- ponseti method (series of plasters for 12 weeks, up to 4 years)
What is congenital hip dysplasia?
- present at birth
- associated with clubfoot and scoliosis
- females more common (hormone related)
What are the clinical features of congenital hip dysplasia?
- double crease and asymmetrical gluteal folds
- extra creases as hip not in acetabulum
- shortened thigh as femur higher in acetabulum
- external rotation
How is congenital hip dysplasia diagnosed?
- Barlow’s test = adduct and push downwards to try and dislocate hip
- Ortolani’s test = abduct hip and try to relocate, push fingers towards into acetabulum
- Galeazzi sign = flex hip and compare height of knees, will be unequal
- radiograohy = x-rays not useful as head of femur just starting to ossify, visualise bone and tissue movement in real life
What is seen on a x-ray in congenital hip dysplasia?
- Hilgenreiner’s Line = horizontal line from 1 acetabulum to other
- perpendicular index line = measures angle along acetabular surface
- Perkin’s line = perpendicular to Hilgenreiner’s line, 2/3 of femoral head should be medial to that line
What is the treatment of congenital hip dysplasia?
- maintain reduction of femoral head in true acetabulum
- subluxation corrects spontaneously
What is the treatment for CHD of a newborn to 6 months?
- Pavlik harness = closed reduction and immbolisation, hip flexed and abducted while still allowing movement, 6 weeks, if hip not reduced in 3 weeks need alternative
- closed reduction
What is the treatment for CHD for older than 6 months?
- open reduction = neck of femur and acetabulum reduced
- need to be careful of AVN and femoral nerve palsies = cannot straighten knee and get foot drop
What happens if CHD is left untreated?
- lead to false acetabulum
- femoral head pushes into ileum posteriorly
- OA
What is Perthe’s disease?
- self limiting AVN of femoral head
- idiopathic
- 4-8 years old
- males
- blood supply re-establishes itself as new ossification forms
What are the 4 stages of Perthe’s?
- necrosis
- fragmentation
- re-ossification
- re-modelling
What is the necrosis stage of Perthe’s?
- portion of femoral head dies
- shape changes
- pain, stiffness, inflammation
- up to 1 year
What is the fragmentation stage of Perthe’s?
- dead cells absorbed and replaced by new bone cells
- femoral head shape varies
- 1-3 years
What is the re-ossification stage of Perthe’s?
- femoral head continues grow with new bone cells
- 1-3 years
What is the re-modelling stage of Perthe’s?
- new bone cells gradually replaced by normal bone cells
- remodelling continues
- 1-3 years or more
What is the treatment for Perthe’s?
- <5/mild = observation, physio, bed rest
- plaster casts/braces = abduction to keep head in acetabulum
- > 5 = surgery, osteotomy
What is a slipped upper femoral epiphysis?
- 10-17 years
- 13 years boys
- 11.5 girls and less severe
- left hip more common
- more boys
What are the risk factors of SUFE?
- obesity
- hypothyroidism
- deficiency or increased androgens
- trauma
(obese, underdeveloped sexual characteristics)
What is the pathophysiology of SUFE?
- fracture of growth plate = slippage of epiphysis
- head of femur remains in acetabulum
- metaphysis moves in anterior direction with external rotation
What are the types of slip in SUFE?
- pre-slip = wide epiphyseal line no slippage
- acute = sudden slippage
- acute-on-chronic = slippage acutely on existing chronic slip
- chronic = steady progressive slippage, most common
What changes happen after a slip in SUFE?
- to epiphyseal plate zones
- hypertrophic zone becomes majority of plate
- Klein’s line pathology
What is Klein’s line?
- in SUFE
- draw along superior border of femoral neck and should cross at least a portion of femoral head but in SUFE head drops below line
What is the treatment for SUFE?
- rest
- analgesia
- surgery = closure of EGP, corrective osteotomy
- bilateral fixation to stop further slippage
What is Blount’s disease?
- growth problem of distal tibia
- tibia varus (medial more weight bearing)
- EGP squashed
- angulation
What is the cause of Blount’s disease?
- unknown
- effects of weight on EGP
- walking early
- genetics
What is the treatment of Blount’s disease?
- brace
- surgical = early onset, when brace fails -> osteotomy, gradual distraction
What is Osgood-Schlatters?
- osteochondritis = disturbance of endochondral ossification
- most common cause of knee pain in children
- self-limiting (symptoms disappear 1 year after onset)
- residual knee pain when kneeling
What is the pathophysiology of Osgood-Schlatters?
- repeated traction from patellar ligament on tibial tuberosity
- avulsion fractures to parts of tibial tuberosity
What is the treatment of Osgood-Schlatters?
- rest
- avoid activites causing pain
- NSAIDs
