Children's orthopaedics Flashcards
What is SCFE/ SCUF?
- Posteromedial displacement of the proximal femoral epiphysis in relation to the neck
- Through the (widened) zone of hypertrophy in the physis
What is the epidemiology of SCFE?
- Age □ range 9-16 years ® males, mean = 13.5 years ® females, mean = 12.0 years - Sex □ males 60% □ females 40% - Incidence □ 2-4/100,000 □ (up to 10/100,000 in USA)
What is the aetiology of SCFE?
- Increased load or weak physis or both □ Idiopathic ® Adolescence ® Delayed bone age ® Increased weight □ Secondary to underlying disorder (GH-IGF axis) ® hypothyroidism ® hypogonadism ® renal osteodystrophy □ growth hormone therapy
What is the history of someone with SCFE?
- Pain- groin/ thigh/ knee
- Limp
- Trauma
- ER deformity
What would be found in a physical examination of someone with SUFE?
- Body habitus
- Externally rotated extremity
- Obligatory external rotation in flexion
- ROM limited by pain
- Healing arthroscopy portals on ipsilateral knee
What would be seen on radiology of someone with SCFE?
- Trethowan’s / Klein’s line
- More obvious on lateral view
- Widened physis
- Horizontal physis (flexion contracture)
- Knee x-rays are usually normal!
- Blanch sign of Steel
- Or just an obvious slip
What types of infections can cause MSK problems in children?
- Septic arthritis
- Osteomyelitis
- Transient synovitis
- Muscle abscess
What history from a child would indicate an MSK infection or inflammation?
- Limp (age dependent)
- Pain
- General malaise/ loss of appetite/ listless
- Temperature
- Recent URTI/ ear infections
- Trauma
- Pseudoparalysis
- Listen to the parent, they are usually right
What would be found on examination of a child with an MSK infection or inflammation?
- Do they look sick?
- Limp?
- Absolute refusal to weight bear?
- Localising area: ankle/ tibia/ knee/ thigh/ hip
□ Hip
® obligatory ER?
® which movements hurt?
□ Ankle: distal tibia or joint line?
□ Knee: joint line or metaphyseal area? - Upper limb disuse
What investigations should be done in a child who has MSK infection or inflammation?
- Temperature
- X-ray
- USS
- Bloods
□ WCC
□ CRP
□ ESR
□ CK
□ Cultures
How ould a child with septic arthritis present?
□ Limping □ Pseudoparalysis □ Swollen, red joint □ Refusal to move joint □ Pain □ Temperature
What investigations should be carried out in a child with septic arthritis?
□ FBC & differential ® Raised WCC >12,000/mm3 □ ESR >50mm/hr □ CRP □ Blood cultures ® +ve in 30-50% □ X-ray □ ULTRASOUND- ALWAYS BE PRESENT □ Synovial fluid ® WCC >50,000/mm3 ® Gram stain ® Culture
How might the presentation of a child with septic arthritis vary?
□ Fever □ Ability to weight bear □ ESR □ CRP □ Serum WCC □ Joint space
What is the treatment of septic arthritis in a child?
□ Typically staph aureus infection □ Aspiration □ Arthroscopy ® Knee/shoulder/ankle □ Arthrotomy □ ANTIBIOTICS ® IV for how long? ® How long a duration?
What is the epidemiology of osteomyelitis in children?
□ Declining □ 2-13/100,000 (up to 200/100,000 in developing countries) □ 3/100,000 (Blyth et al, Glasgow 1997) □ Mean age 6 years (10yrs pelvic) □ Risk factors (1/3) ® Blunt trauma ® Recent infection
