Children's Orthopaedics Flashcards
List 3 characteristics of bone in children
- Less dense and more porous than adult bones (bend, buckle)
- Thicker periosteum: more rapid healing
- Remodeling
List 4 possible causes of fractures in infants
- rare
- birth trauma
- child abuse
- osteogenesis imperfecta
What is a greenstick fracture and where is it most commonly seen?
Why do these occur in children?
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)
List the catagories of the Salter Harris classification
List 4 treatments for ‘immobilisation’ of a fracture
- cast
- traction
- bedrest
- brace
List 4 causes of a ‘limp’ in a child (there is heaps!)
List 4 important hip conditions in children we MUST identify
List 4 other differentials for a painful hip
- Sepsis
- Leg Calve Perthes Disease
- SUFE (slipped upper femoral epiphysis)
- DDH (clicky hips)
- synovitis
- Juvenile Arthritis
- septic arthritis
- blood disorders
Give the pathophysiology of ????
Transphysial blood vessels Seive like arrangements Immunity
List 4 investigations used to diagnose hip pathologies in children?
What is Kocher’s Criteria and give the parameters
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
How do we manage septic arthritis in a child
What is Leg-Calve-Perthes Disease
Idiopathic avascular necrosis of femoral head, commonly presents between 5–7 with insidious onset of hip pain that may cause child to limp
Give the common presentation of Perthes disease
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
State and explain the classification system for Perthes disease?
Herring (Lateral Pillar) Classification
- A <50 %
- B >50%
- C Whole head
- B / C Age at presentation
List 4 Prognostic Factors of Perthes
- Age of onset
- Extent of epiphyseal involvement
- Range of movement
- Femoral Metaphyseal Involvement (at risk)
- Acetabular Congruity
- Type of treatment (?)
- Stage at treatment initiation (?)
List 4 broad management options for Perthes and incl pros/cons of each
What does SUFE stand for and what is it
Slipped Upper (Capital) Femoral Epiphysis
List 4 risk factors for SUFE
- obesity
- hypothyroidism
- hereditary factors
- post radiation
- weakened physeal plate
List 2 presentations of SUFE that can be identified without an X-ray
Pain (at thigh or knee)
Gait (antalgic)
List the 4 types of slip, SUFE can present with
- Pre–Slip
- Acute (Unstable) Slip 10%
- Chronic (Stable) Slip
- Acute on Chronic
How can SUFE be classified and how does treatment differ for each?
- Mild < 30% ➞ Fix in situ
- Moderate 30-70% ➞ Fix in situ/ Osteotomy
- Severe >70% ➞ Osteotomy
Give 4 causes of Clicky / Hypermobile Joints
What is DDH (D(C)DH)
Developmental (congenital) Dislocation of Hip
How may DDH present during different stages of life
Give 4 risk factors for DDH
- family history
- breech position
- oligohydramnios
- myelomeningocele
- first-born child
Management of DDH?
- Observation (may also use Pavlik harness)
- Surgical (open reduction)
List 3 differentials for Toeing in/Toeing out
Hip: Excessive Femoral Ante-version
Tibia: Tibial In-torsion
Feet: Metatarsus Varus
Give the Pathology of Intoeing
???
How do we manage Torsion?
- Explanation
- Reassurance
- Offer to follow
Usually self-resolving
What is shown in the below?
Metatarsus Varus
How do we treat Tibial Torsion?
- Bracing
- Postural
- Surgical (complication = non/delayed union, infection)
List 4 causes of pes planus (flat foot)
- Idiopathic (Flexible) – Clacaneovalgus
- Tarsal Coaltition (Talo-Navicular, Talo Calcaneal)
- Congenital Vertical Talus
- Subtalar Rheumatoid Arthritis
- Rotatory / Angular Malalignment
- Neuromuscular Disorders
What is the management for Flat Foot
What is the medical name for club foot
List 4 potential causes
Congenital Talipes Equinvarus?
Causes
- Intra uterine packaging defect
- Neuromuscular disorders
- Germ Plasm defect
- Hereditary
Give the 3 severities of club foot
- Non Rigid
- Rigid (moderate-severe)
- Teratologic (common in arthrogryposis and spinal bifida)
What is the management of club foot
Casts (Kite, Ponsetti)
Surgical (Turco, Cincinatti)
What is the Ponsetti Method
Main treatment for correction of the forefoot varus and suppination (club foot)
- serial casting at one week interval
- complete TA tenotomy
- brace 23/24 for 4 months
- brace for 2 years
Give 3 treatment options for a Bunion
- Foot wear modification
- Soft tissue release
- Lateral Displacement osteotomy
(Recurrence 60%)
What is Accessory Navicular and how do we manage?
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
How do we manage Curly Toes?
ive 3 complications of curly toes?
No treatment! Could do Flexor Tenotomies
Complications: Pain, footwear problems, callosities
