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MSK block > Children's Orthopaedics > Flashcards

Children's Orthopaedics Flashcards

1
Q

List 3 characteristics of bone in children

A
  1. Less dense and more porous than adult bones (bend, buckle)
  2. Thicker periosteum: more rapid healing
  3. Remodeling
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2
Q

List 4 possible causes of fractures in infants

A
  • rare
  • birth trauma
  • child abuse
  • osteogenesis imperfecta
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3
Q

What is a greenstick fracture and where is it most commonly seen?

Why do these occur in children?

A

break occurs through the periosteum on one side of the bone while only bowing or buckling on the other side. Seen most frequently in forearm

Occur in children because their bones are more flexible (can bend or buckle)

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4
Q

List the catagories of the Salter Harris classification

A
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5
Q

List 4 treatments for ‘immobilisation’ of a fracture

A
  • cast
  • traction
  • bedrest
  • brace
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6
Q

List 4 causes of a ‘limp’ in a child (there is heaps!)

A
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7
Q

List 4 important hip conditions in children we MUST identify

List 4 other differentials for a painful hip

A
  1. Sepsis
  2. Leg Calve Perthes Disease
  3. SUFE (slipped upper femoral epiphysis)
  4. DDH (clicky hips)
  5. synovitis
  6. Juvenile Arthritis
  7. septic arthritis
  8. blood disorders
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8
Q

Give the pathophysiology of ????

A

Transphysial blood vessels Seive like arrangements Immunity

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9
Q

List 4 investigations used to diagnose hip pathologies in children?

A
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10
Q

What is Kocher’s Criteria and give the parameters

A

Tool used in the differentiation of septic arthritis from transient synovitis in the child with a painful hip.

  • Fever
  • Raised Inflammatory Markers (WCC / ESR / CRP)
  • Hip Effusion on ultrasound scan
  • Aspiration?
  • Radiological Features
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11
Q

How do we manage septic arthritis in a child

A
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12
Q

What is Leg-Calve-Perthes Disease

A

Idiopathic avascular necrosis of femoral head, commonly presents between 5–7 with insidious onset of hip pain that may cause child to limp

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13
Q

Give the common presentation of Perthes disease

A

Painful limp, localised to the groin (may be reffered to the antero-medial thigh or knee region)

It has an Insidious onset and is activity-related + relieved by rest

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14
Q

State and explain the classification system for Perthes disease?

A

Herring (Lateral Pillar) Classification

  • A <50 %
  • B >50%
  • C Whole head
  • B / C Age at presentation
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15
Q

List 4 Prognostic Factors of Perthes

A
  • Age of onset
  • Extent of epiphyseal involvement
  • Range of movement
  • Femoral Metaphyseal Involvement (at risk)
  • Acetabular Congruity
  • Type of treatment (?)
  • Stage at treatment initiation (?)
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16
Q

List 4 broad management options for Perthes and incl pros/cons of each

A
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17
Q

What does SUFE stand for and what is it

A

Slipped Upper (Capital) Femoral Epiphysis

18
Q

List 4 risk factors for SUFE

A
  1. obesity
  2. hypothyroidism
  3. hereditary factors
  4. post radiation
  5. weakened physeal plate
19
Q

List 2 presentations of SUFE that can be identified without an X-ray

A

Pain (at thigh or knee)

Gait (antalgic)

20
Q

List the 4 types of slip, SUFE can present with

A
  1. Pre–Slip
  2. Acute (Unstable) Slip 10%
  3. Chronic (Stable) Slip
  4. Acute on Chronic
21
Q

How can SUFE be classified and how does treatment differ for each?

A
  1. Mild < 30% ➞ Fix in situ
  2. Moderate 30-70% ➞ Fix in situ/ Osteotomy
  3. Severe >70% ➞ Osteotomy
22
Q

Give 4 causes of Clicky / Hypermobile Joints

A
23
Q

What is DDH (D(C)DH)

A

Developmental (congenital) Dislocation of Hip

24
Q

How may DDH present during different stages of life

A
25
Q

Give 4 risk factors for DDH

A
  1. family history
  2. breech position
  3. oligohydramnios
  4. myelomeningocele
  5. first-born child
26
Q

Management of DDH?

A
  1. Observation (may also use Pavlik harness)
  2. Surgical (open reduction)
27
Q

List 3 differentials for Toeing in/Toeing out

A

Hip: Excessive Femoral Ante-version

Tibia: Tibial In-torsion

Feet: Metatarsus Varus

28
Q

Give the Pathology of Intoeing

A
29
Q

???

A
30
Q

How do we manage Torsion?

A
  • Explanation
  • Reassurance
  • Offer to follow

Usually self-resolving

31
Q

What is shown in the below?

A

Metatarsus Varus

32
Q

How do we treat Tibial Torsion?

A
  1. Bracing
  2. Postural
  3. Surgical (complication = non/delayed union, infection)
33
Q

List 4 causes of pes planus (flat foot)

A
  1. Idiopathic (Flexible) – Clacaneovalgus
  2. Tarsal Coaltition (Talo-Navicular, Talo Calcaneal)
  3. Congenital Vertical Talus
  4. Subtalar Rheumatoid Arthritis
  5. Rotatory / Angular Malalignment
  6. Neuromuscular Disorders
34
Q

What is the management for Flat Foot

A
35
Q

What is the medical name for club foot

List 4 potential causes

A

Congenital Talipes Equinvarus?

Causes

  • Intra uterine packaging defect
  • Neuromuscular disorders
  • Germ Plasm defect
  • Hereditary
36
Q

Give the 3 severities of club foot

A
  1. Non Rigid
  2. Rigid (moderate-severe)
  3. Teratologic (common in arthrogryposis and spinal bifida)
37
Q

What is the management of club foot

A

Casts (Kite, Ponsetti)

Surgical (Turco, Cincinatti)

38
Q

What is the Ponsetti Method

A

Main treatment for correction of the forefoot varus and suppination (club foot)

  1. serial casting at one week interval
  2. complete TA tenotomy
  3. brace 23/24 for 4 months
  4. brace for 2 years
39
Q

Give 3 treatment options for a Bunion

A
  • Foot wear modification
  • Soft tissue release
  • Lateral Displacement osteotomy

(Recurrence 60%)

40
Q

What is Accessory Navicular and how do we manage?

A

An extra bone or piece of cartilage located on inner side of the foot just above the arch

Conservative / Expectant ➞ requires footwear modification, arch support

Surgical ➞ can cause scarring and Inflamation

41
Q

How do we manage Curly Toes?

ive 3 complications of curly toes?

A

No treatment! Could do Flexor Tenotomies

Complications: Pain, footwear problems, callosities

MSK block (30 decks)

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