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Musculo-skeletal > Children's Orthopaedics > Flashcards

Children's Orthopaedics Flashcards

1
Q

Which hip problems are more common for children aged between 0-5?

A
  • Trauma
  • Transient synovitis
  • Osteomyelitis
  • Septic arthritis
  • DDH
  • JIA
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2
Q

Which hip problems are more common for children aged between 5-10?

A
  • Trauma
  • Osteomyelitis
  • Transient synovitis
  • Septic arthritis
  • Legg-Calve Perthes disease
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3
Q

Which hip problems are more common for children aged between 10-15?

A
  • Trauma
  • Osteomyelitis
  • Septic arthritis
  • SUFE
  • Chondromalacia
  • Neoplasm
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4
Q

Which population groups are more likely to have developmental dysplasia of the hip

A
  • European populations
  • Girls > boys
  • First borns
  • Birth problems: breech and oligohydramnios (lack of amniotic fluid)
  • FH
  • Lower limb deformities
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5
Q

What are the clinical features of DDH?

A
  • Ortolani’s sign (positive if a clunk is heard as the femoral head is abducted and slides over the posterior rim of the acetabulum and is reduced: dislocated)
  • Barlow’s sign: examiner attempts to dislocate the femoral head using posterior/lateral pressure
  • Piston Motion sign
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6
Q

How can DDH be managed?

A
  • Casts
  • Splinting
  • Surgery
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7
Q

What is the presentation of Legg-Calve-Perthes disease?

A
  • Males > females
  • Primary school age
  • Short stature
  • Limp
  • Knee pain on exercise
  • Stiff hip joint
  • Systemically well
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8
Q

Name the phases of LCP

A
  • Avascular necrosis
  • Fragmentation - revascularisation
  • Reossification
  • Residual deformity
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9
Q

List the unilateral differential diagnoses for LCP

A
  • Septic hip
  • JIA
  • SCFE
  • Lymphoma
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10
Q

List the bilateral differential diagnoses for LCP

A
  • Hypothyroid
  • Sickle
  • Epiphyseal dysplasia
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11
Q

How can LCP be treated?

A
  • Maintain hip motion
  • Analgesia
  • Restrict painful actvities
  • Containment - osteotomy
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12
Q

What is the presentation of SUFE/SCFE (slipped capital femoral epiphysis)?

A
  • Teenage boys > girls (9-14 yrs)
  • Pain in hip or knee
  • External posture and gait
  • Reduced internal rotation, especially in flexion
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13
Q

How is SUFE/SCFE classified?

A
  • Acute vs chronic (3 weeks)

- Stable vs unstable

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14
Q

How can SUFE/SCFE be treated?

A

-Surgery

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15
Q

What are the potential consequences of SCFE/SUFE?

A
  • AVN
  • Chondrolysis
  • Deformity
  • Early osteoarthritis
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16
Q

Name the five most common causes of limp in children

A
  • Toxic synovitis
  • Septic arthritis
  • Trauma
  • Osteomyelitis
  • Viral syndromes
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17
Q

What is the most common site of origin for a limp in children?

A

Hip

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18
Q

What are the causes of limp in children aged 0-5 yrs?

A
  • Normal variant
  • Trauma
  • Transient synovitis
  • Osteomyelitis
  • Septic arthritis
  • DDH
  • JIA
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19
Q

What are the causes of limp in children aged 5-10yrs?

A
  • Trauma
  • Transient synovitis
  • Osteomyelitis
  • Septic arthritis
  • Perthes
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20
Q

What are the causes of limp in children aged 10-15yrs?

A
  • Trauma
  • Osteomyelitis
  • Septic arthritis
  • SUFE
  • Chondromalacia
  • Neoplasm
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21
Q

Which features on a history would make an infection more likely?

A
  • Limp
  • Pain
  • Malaise/loss of appetite/listless
  • Temperature
  • Recent URTI/ear infections
  • Trauma
  • Pseudoparalysis
22
Q

What initial investigations would you do if you suspected an infection?

A
  • Temperature
  • X-ray or USS
  • Bloods: WCC, CRP, ESR, CK and cultures
23
Q

How does septic arthritis present?

A
  • Limping
  • Pseudoparalysis
  • Swollen, red joint
  • Refusal to move joint
  • Pain
  • Temperature
24
Q

Name the top 3 common sites for septic arthritis

A
  • Knee
  • Hip
  • Ankle
25
Q

What investigations should be done for septic arthritis?

A
  • FBC, ESR, CRP and cultures
  • X-ray
  • USS
  • Synovial fluid: WCC, gram stain and culture
26
Q

What are the Kocher criteria for septic arthritis?

A
  • Pyrexia
  • Non weight bearing
  • WBC > 12,000/ml
  • ESR > 40mm/hr
27
Q

What is the treatment of septic arthritis?

A
  • Aspiration
  • Arthroscopy
  • Arthrotomy
  • Antibiotics (2 weeks IV and 6 weeks in total)
28
Q

How does osteomyelitis present?

A
  • Pain
  • Localised signs and symptoms
  • Fever
  • Reduced range of movement
  • Reduced weight bearing
29
Q

What initial investigations should be done for osteomyelitis?

A
  • X ray
  • CRP
  • ESR
  • WCC
  • Blood culture
30
Q

What are the indications for surgery in osteomyelitis?

A
  • Aspiration for culture
  • Drainage of subperiosteal abscess
  • Drainage of joint sepsis
  • Debridement of dead tissue
  • Failure to improve
  • Biopsy in equivocal cases
31
Q

What are the features of transient synovitis?

A
  • Limping, often touch weight bearing
  • Slightly unwell
  • History of viral infection
  • Apyrexial
  • Low CRP, normal WCC
  • May have joint infusion
32
Q

Which features raise a concern of cancer?

A
  • Night pain
  • Incidental trauma
  • Stops doing sport/going out
  • Sweats and fatigue
  • Abnormal blood results: low haemaglobin, atypical blood film and atypical platelets
33
Q

What is a galeazzi fracture?

A

a fracture of the distal third of the radius with dislocation of the distal radioulnar joint

34
Q

What is a monteggia fracture?

A

a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius

35
Q

What should be assessed when a child presents with a bone fracture?

A
  • History: mechanism
  • Deformity
  • Soft tissue: wounds, sensation, motor function and vascular status
36
Q

What are the indications for surgery for a fracture?

A
  • <9yrs: >15 angulation and >45 malrotation
  • > 9 yrs: proximal >10 angulation and >30 malrotation and distal >15 angulation
  • Open fracture
  • Segmental
  • NV compromise
  • Failed closed
37
Q

What are the principles of closed management?

A
  • Analgesia
  • Reduce: disimpact and bend force over apex
  • Molded cast 4-6 weeks
  • Restrict activity for 3-4 months
38
Q

What are the complications of radial fractures?

A
  • Compartment surgery
  • Radioulnar synostasis
  • PIN injury
  • Superficial radial nerve injury
  • DRUJ/radiocapitellar problems
39
Q

How can distal radial fractures be managed?

A
  • Buckle: cast for 3-4 weeks
  • Greenstick: cast for 4-6 weeks
  • Complete: cast +/- K wires 6 weeks
40
Q

What are the risks for remanipulation in distal radial fractures?

A
  • Complete fractures

- Failed autonomic reduction

41
Q

What are the differential diagnoses for knee trauma?

A
  • Infection
  • Inflammatory arthropathy
  • Neoplasm
  • Apophysitis
  • Hip or foot
  • Sickle haemophilia
42
Q

What are the causes of physeal injury and how can they be treated?

A
  • Hyperextension and varus - CPN injury
  • Cast, percutaneous fix, ORIF articular displacement and
  • Range of motion early
43
Q

What are the different types of tibial spine injuries?

A
  • I: undisplaced
  • II: hinged
  • III: displaced
44
Q

How can tibial spine injuries be treated?

A
  • I/II: long leg cast

- II/III: ORIF/AxIF

45
Q

How can patellar fractures be treated?

A
  • Undisplaced: cylinder cast

- Displaced: ORIF

46
Q

What are the risk factors for patellar dislocation?

A
  • Laxity
  • Poor VMO
  • Q angle
  • Femoral anteversion
  • Tibial external rotation
  • Patella alta
47
Q

How can patellar dislocations be managed?

A
  • Cast for two weems
  • Mobilise
  • VMO exercises
48
Q

What is Osgood-Schlatter’s disease?

A

Inflammation of the patellar ligament at the tibial tuberosity (apophysitis)

49
Q

What is Sever’s disease

A

Swelling and irritation of the growth plate in the heel

50
Q

What are the warnings of a potential NAI?

A
  • Incongruent history
  • Pattern of bruising
  • Burns
  • Multiple fractures in multiple stages of healing
  • Metaphyseal and humeral shaft fractures
  • Rib fractures
  • Non ambulant fractures

Musculo-skeletal (27 decks)

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