Children orthopaedics

Question 1

what are the 3 main orthopaedic conditions found in children?

Answer 1

Developmental dysplasia of the hip
Perthes disease
Slipped capital femoral epiphysis

Question 2

what increases the risk of a child having developmental dysplasia of the hip?

Answer 2

first born 
oligohydramnios 
breech presentation / C-section
family history 
other lower limb deformities 
large baby > 10 pounds

Question 3

what are the clinical features of DDH?

Answer 3

ortolans’s sign
barlow’s sign
piston motion sign
(but only 40% of DDH is picked up by examination)

Question 4

what investigation is helpful to identify DDH?

Answer 4

ultrasound scan of the hip

Question 5

what age and sex is Legg-calve-Perthes disease most common in?

Answer 5

male:female 5:1

primary school age

Question 6

what are the features of Perthes disease?

Answer 6

short statures
limp
knee pain on exercise
stiff hip joint 
systemically unwell

Question 7

what are the phases of perthes disease?

Answer 7

avascular necrosis
fragmentation - revascularisation (pain)
reossification (bony healing)
residual deformity

Question 8

what are the treatments for Perthes disease?

Answer 8

maintain hip motion
analgesia
restrict painful activities
‘containment’ - consider osteotomy in selected groups of children (>7)

Question 9

what is SCFE?

Answer 9

slipped capital femoral epiphysis

slipped upper femoral femoral epiphysis

Question 10

what percentage of children have bilateral Perthes disease?

Answer 10

10%

Question 11

what is the presentation of of SCFE?

Answer 11

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)

Question 12

what are the complications/outcomes of SCFE?

Answer 12

avascular necrosis
chondrolysis
deformity
early osteoarthritis 
possibility of slip on other side 
limb leg discrepancy 
impingement

Question 13

what helps you identify SCFE on x-ray?

Answer 13

Trethowan’s sign

Question 14

how is SCFE managed?

Answer 14

stable slips
- pinned
unstable slips
- open reduction

Question 15

is SCFE more common in males or female? and what age is most common?

Answer 15

teenage boys>girls

9-14 yrs

Question 16

what are the classifications of SCFE/SUFE?

Answer 16

acute vs chronic (3 months)

stable vs unstable

Question 17

what sign is found on x-ray which is positive for SCFE?

Answer 17

trethowan’s sign

Question 18

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?

Answer 18

Perthes disease

Question 19

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?

Answer 19

Slipped capital femoral epiphysis

Question 20

describe Barlows and Ortolans sign.

Answer 20

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

Question 21

what is the most consisted clinical feature of DDH?

Answer 21

limited abduction

Question 22

what are the clinical presentations of DDH in a child > 12 months?

Answer 22

trendelenberg gait
positive Galeazzia sign
asymmetric hip abduction

Question 23

after how long will barlow’s and ortolani’s sign not be positive on clinical examination?

Answer 23

after 3 months

rely on limited hip abduction for clinical exam + x-ray