Childhood

Question 1

Summarise fractures in children

Answer 1

Pathophysiology: Children’s bones are more flexible and less strong, however heal faster

Types:
Greenstick - one side bone breaks, other is fine
Buckle fracture - bone bends
Salter-Harris - growth plate

Mx:
Safeguarding
Closed (manipulation)/ open reduction (surgery)
Stability via casts/ K wires/ intramedullary wires/ intramedullary nails/ screws/ plates
Pain mx - Paracetamol/ ibuprofen –> Morphine
NO codeine, aspirin or tramadol

Question 2

Summarise Transient Synovitis

Answer 2

Pathophysiology: Temporary inflammation synovial membrane secondary to URTI

Presentation: Usually 3-10 years (Primary school), limo, no wt bearing, hip pain, mild temperature, NO systemic illness

Mx:
Supportive, safety net - F/U 48 hrs and 1 week

Question 3

Summarise Perthe’s Disease

Answer 3

Pathophysiology: Avascular necrosis of the femoral head, affecting the epiphysis

Presentation: Primary school age, gradual hip pain, limp, reduced ROM

Ix: XR

Mx: Rest, traction, clutches, analgesia, PT, XR to assess healing, surgery (THR) if severe

Question 4

Summarise Slipper Upper Femoral Epiphysis

Answer 4

Pathophysiology: Head femur displaced along the growth plate

Presentation: Secondary school age, obese, potentially hx minor trauma.
hip, groin, knee pain, restricted ROM, limp, restricted internal rotation particularly

Ix: XR

Mx: surgery to fix position

Question 5

Summarise DDH

Answer 5

Pathophysiology: Instability in hips –> potential for subluxation/ dislocation

RF: First degree fhx, breech, multiple pregnancy

Presentation: Ortolani (Dislocate) + Barlow (Relocate) on NIPE; clicking

Ix: US first line

Mx: Pavlik harness <6 m, surgery if harness fails/ late diagnosis

Question 6

Summarise Osgood-Schlatter’s Disease

Answer 6

Pathophysiology: Stress –> nflammation of tibial tuberosity at patella insertion leading to small avulsion fractures –> Tibial tuberosity grows

Presentation: Active teenage male, unilateral, palpable hard and tender lump on tibial tuberosity, pain which is worse on activity especially extension

Mx:
RICE, NSAIDs, PT

Question 7

Summarise Osteogenesis Imperfecta

Answer 7

Pathophysiology: Genetic condition –> Brittle bones due to malformation of collagen

Presentation: Hypermobility, blue/ grey sclera, triangular face, short, deaf, dental issues, bowed legs, joint and bone pain

Ix: XR for deformities and fractures, genetic testing

Mx: MDT, bisphosphonates and Vit D