Children's Orthopaedics Flashcards
Which hip problems are more common for children aged between 0-5?
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- DDH
- JIA
Which hip problems are more common for children aged between 5-10?
- Trauma
- Osteomyelitis
- Transient synovitis
- Septic arthritis
- Legg-Calve Perthes disease
Which hip problems are more common for children aged between 10-15?
- Trauma
- Osteomyelitis
- Septic arthritis
- SUFE
- Chondromalacia
- Neoplasm
Which population groups are more likely to have developmental dysplasia of the hip
- European populations
- Girls > boys
- First borns
- Birth problems: breech and oligohydramnios (lack of amniotic fluid)
- FH
- Lower limb deformities
What are the clinical features of DDH?
- 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
How can DDH be managed?
- Casts
- Splinting
- Surgery
What is the presentation of Legg-Calve-Perthes disease?
- Males > females
- Primary school age
- Short stature
- Limp
- Knee pain on exercise
- Stiff hip joint
- Systemically well
Name the phases of LCP
- Avascular necrosis
- Fragmentation - revascularisation
- Reossification
- Residual deformity
List the unilateral differential diagnoses for LCP
- Septic hip
- JIA
- SCFE
- Lymphoma
List the bilateral differential diagnoses for LCP
- Hypothyroid
- Sickle
- Epiphyseal dysplasia
How can LCP be treated?
- Maintain hip motion
- Analgesia
- Restrict painful actvities
- Containment - osteotomy
What is the presentation of SUFE/SCFE (slipped capital femoral epiphysis)?
- Teenage boys > girls (9-14 yrs)
- Pain in hip or knee
- External posture and gait
- Reduced internal rotation, especially in flexion
How is SUFE/SCFE classified?
- Acute vs chronic (3 weeks)
- Stable vs unstable
How can SUFE/SCFE be treated?
-Surgery
What are the potential consequences of SCFE/SUFE?
- AVN
- Chondrolysis
- Deformity
- Early osteoarthritis
Name the five most common causes of limp in children
- Toxic synovitis
- Septic arthritis
- Trauma
- Osteomyelitis
- Viral syndromes
What is the most common site of origin for a limp in children?
Hip
What are the causes of limp in children aged 0-5 yrs?
- Normal variant
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- DDH
- JIA
What are the causes of limp in children aged 5-10yrs?
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- Perthes
What are the causes of limp in children aged 10-15yrs?
- Trauma
- Osteomyelitis
- Septic arthritis
- SUFE
- Chondromalacia
- Neoplasm
Which features on a history would make an infection more likely?
- Limp
- Pain
- Malaise/loss of appetite/listless
- Temperature
- Recent URTI/ear infections
- Trauma
- Pseudoparalysis
What initial investigations would you do if you suspected an infection?
- Temperature
- X-ray or USS
- Bloods: WCC, CRP, ESR, CK and cultures
How does septic arthritis present?
- Limping
- Pseudoparalysis
- Swollen, red joint
- Refusal to move joint
- Pain
- Temperature
Name the top 3 common sites for septic arthritis
- Knee
- Hip
- Ankle
What investigations should be done for septic arthritis?
- FBC, ESR, CRP and cultures
- X-ray
- USS
- Synovial fluid: WCC, gram stain and culture
What are the Kocher criteria for septic arthritis?
- Pyrexia
- Non weight bearing
- WBC > 12,000/ml
- ESR > 40mm/hr
What is the treatment of septic arthritis?
- Aspiration
- Arthroscopy
- Arthrotomy
- Antibiotics (2 weeks IV and 6 weeks in total)
How does osteomyelitis present?
- Pain
- Localised signs and symptoms
- Fever
- Reduced range of movement
- Reduced weight bearing
What initial investigations should be done for osteomyelitis?
- X ray
- CRP
- ESR
- WCC
- Blood culture
What are the indications for surgery in osteomyelitis?
- Aspiration for culture
- Drainage of subperiosteal abscess
- Drainage of joint sepsis
- Debridement of dead tissue
- Failure to improve
- Biopsy in equivocal cases
What are the features of transient synovitis?
- Limping, often touch weight bearing
- Slightly unwell
- History of viral infection
- Apyrexial
- Low CRP, normal WCC
- May have joint infusion
Which features raise a concern of cancer?
- Night pain
- Incidental trauma
- Stops doing sport/going out
- Sweats and fatigue
- Abnormal blood results: low haemaglobin, atypical blood film and atypical platelets
What is a galeazzi fracture?
a fracture of the distal third of the radius with dislocation of the distal radioulnar joint
What is a monteggia fracture?
a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius
What should be assessed when a child presents with a bone fracture?
- History: mechanism
- Deformity
- Soft tissue: wounds, sensation, motor function and vascular status
What are the indications for surgery for a fracture?
- <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
What are the principles of closed management?
- Analgesia
- Reduce: disimpact and bend force over apex
- Molded cast 4-6 weeks
- Restrict activity for 3-4 months
What are the complications of radial fractures?
- Compartment surgery
- Radioulnar synostasis
- PIN injury
- Superficial radial nerve injury
- DRUJ/radiocapitellar problems
How can distal radial fractures be managed?
- Buckle: cast for 3-4 weeks
- Greenstick: cast for 4-6 weeks
- Complete: cast +/- K wires 6 weeks
What are the risks for remanipulation in distal radial fractures?
- Complete fractures
- Failed autonomic reduction
What are the differential diagnoses for knee trauma?
- Infection
- Inflammatory arthropathy
- Neoplasm
- Apophysitis
- Hip or foot
- Sickle haemophilia
What are the causes of physeal injury and how can they be treated?
- Hyperextension and varus - CPN injury
- Cast, percutaneous fix, ORIF articular displacement and
- Range of motion early
What are the different types of tibial spine injuries?
- I: undisplaced
- II: hinged
- III: displaced
How can tibial spine injuries be treated?
- I/II: long leg cast
- II/III: ORIF/AxIF
How can patellar fractures be treated?
- Undisplaced: cylinder cast
- Displaced: ORIF
What are the risk factors for patellar dislocation?
- Laxity
- Poor VMO
- Q angle
- Femoral anteversion
- Tibial external rotation
- Patella alta
How can patellar dislocations be managed?
- Cast for two weems
- Mobilise
- VMO exercises
What is Osgood-Schlatter’s disease?
Inflammation of the patellar ligament at the tibial tuberosity (apophysitis)
What is Sever’s disease
Swelling and irritation of the growth plate in the heel
What are the warnings of a potential NAI?
- Incongruent history
- Pattern of bruising
- Burns
- Multiple fractures in multiple stages of healing
- Metaphyseal and humeral shaft fractures
- Rib fractures
- Non ambulant fractures
