Children orthopaedics Flashcards
what are the 3 main orthopaedic conditions found in children?
Developmental dysplasia of the hip
Perthes disease
Slipped capital femoral epiphysis
what increases the risk of a child having developmental dysplasia of the hip?
first born oligohydramnios breech presentation / C-section family history other lower limb deformities large baby > 10 pounds
what are the clinical features of DDH?
ortolans’s sign
barlow’s sign
piston motion sign
(but only 40% of DDH is picked up by examination)
what investigation is helpful to identify DDH?
ultrasound scan of the hip
what age and sex is Legg-calve-Perthes disease most common in?
male:female 5:1
primary school age
what are the features of Perthes disease?
short statures limp knee pain on exercise stiff hip joint systemically unwell
what are the phases of perthes disease?
avascular necrosis
fragmentation - revascularisation (pain)
reossification (bony healing)
residual deformity
what are the treatments for Perthes disease?
maintain hip motion
analgesia
restrict painful activities
‘containment’ - consider osteotomy in selected groups of children (>7)
what is SCFE?
slipped capital femoral epiphysis
slipped upper femoral femoral epiphysis
what percentage of children have bilateral Perthes disease?
10%
what is the presentation of of SCFE?
pain in hip or knee
external rotated leg/foot
externally rotated gait
as you bend the knee the knee externally rotates (reduced internal rotation in flexion)
what are the complications/outcomes of SCFE?
avascular necrosis chondrolysis deformity early osteoarthritis possibility of slip on other side limb leg discrepancy impingement
what helps you identify SCFE on x-ray?
Trethowan’s sign
how is SCFE managed?
stable slips
- pinned
unstable slips
- open reduction
is SCFE more common in males or female? and what age is most common?
teenage boys>girls
9-14 yrs
what are the classifications of SCFE/SUFE?
acute vs chronic (3 months)
stable vs unstable
what sign is found on x-ray which is positive for SCFE?
trethowan’s sign
A 9 year old boy presents with a stiff hip, painful knee during exercise, is short for his age and has a limp.
what is the most likely diagnosis?
Perthes disease
a boy of 10 years age presents with a painful groin for 3 months, his leg appears to be externally rotated and he cannot weight bare.
hat is the most likely diagnosis?
Slipped capital femoral epiphysis
describe Barlows and Ortolans sign.
barlows sign is positive when you when you feel a clicking sensation of the femoral head dislocating from the acetabulum
ortolani’s sign confirms barlows sign if the femoral head goes back into the socket
what is the most consisted clinical feature of DDH?
limited abduction
what are the clinical presentations of DDH in a child > 12 months?
trendelenberg gait
positive Galeazzia sign
asymmetric hip abduction
after how long will barlow’s and ortolani’s sign not be positive on clinical examination?
after 3 months
rely on limited hip abduction for clinical exam + x-ray
