Cortex - Paediatric orthopaedics 4 Flashcards
What is perthes disease ?
It is an idiopathic osteochondritis of the femoral head
Who and what age range does perthes disease most commonly present in ?
Boys 5:1, around ages 4-9yrs old
Describe the progression of perthes disease and what complications it can result in
Results in loss of blood supply to femoral head ==> necrosis ==> femoral head may collapse ==> subsequent remodelling occurs
May lead to early arthritis, with severe cases potentially requiring hip replacement in adolescence or early adulthood
What is the presentation of perthes disease ?
- Affected children present with pain and a limp
- Loss of internal rotation is usually the first clinical sign
- Followed by loss of abduction and later on a positive Trendellenburg test from gluteal weakness.
What is the treatment of perthes disease?
1st line - regular xray observation and avoidance of physical activity (supportive)
Occasionally the femoral head may sublux (partially dislocate) requiring an osteotomy of the femur or acetabulum.
What is a slipped upper femoral epiphysis ?
Femoral head epiphysis slips inferiorly in relation to the femoral neck.
Who is SUFE most common in ?
Overweight pre‐pubertal adolescent boys
Describe the presentation of SUFE
Patients have pain and a limp. The pain may be felt in the groin
The major pitfall is that patients can present purely with pain in the knee (due to obturator nerve supplying both hip and knee joint)
Loss of internal rotation of the hip is the predominant clinical sign
What is the treatment of SUFE?
1st line - Urgent surgery to pin the femoral head
How is SUFE detected ?
- Bilateral antero-posterior x-rays
- Frog-leg lateral x-rays (lateral view key to detecting mild slips)
Define what is meant by the term knee extensor mechanism problems and what strctures they involve
Knee extensor mechanism injuries can involve the quadriceps tendon, patellar tendon, patella, or tibial tubercle.
What are the 3 main types of knee extensor mechanism problems that we should know about ?
- Patellar tendonitis
- Osgood schlatters disease
- Sinding‐Larsen‐Johanssen disease
Describe the typical presentation of patellar tendonitis
This is also known as jumpers knee - seen most commonly in athletes playing jumping sports e.g. basketball, volleyball etc, also in adolescents as body weight increases
Pain is the main symptom (usually between your patellar where the tendon attaches to your shinbone (tibia)).
Describe the typical presentation of osgood schlatters disease
Pain, swelling and tenderness of the tibial tubercle
Describe the typical presentation of Sinding‐Larsen‐Johanssen disease
The presentation is with point tenderness at the inferior pole of the patella associated with focal swelling.
What is the treatment for the 3 extensor mechanism knee problems mentioned ?
Rest +/‐ physiotherapy
Describe what anterior knee pain (patellofemoral dysfunction) is ?
It is pain that originates in the patellofemoral joint
May bedue to muscle imbalance, ligamentous laxity etc
Who is most commonly affected by patellofemoral dysfunction and what exacerbates the condition?
- Common in adolescence, especially in girls
- It is worse when walking downstairs, with prolonged sitting or when first getting up from a chair.
What is the mainstay of treatment for patellofemoral dysfunction?
Physiotherapy to rebalance the muscles
Describe the typical mechanism/presentation of dislocation or subluxation of the knee cap
It’s often caused by a blow or a sudden change in direction when the leg is planted on the ground, such as during sports or dancing.
The kneecap (patella) normally sits over the front of the knee
What is the treatment for dislocation or subluxation of the knee cap ?
- Usually pops back in by itself
- Physiotherapy
- Recurrent dislocation may require surgery to correct any bony predisposition or to reconstruct the medial patellofemoral ligament.
Reminder:
- What is osteochondritis dissecans ?
- How does it present and what is the treatment of it ?
- It is an osteochondritis where fragments of hyaline cartilage breaks off
- Patients present with poorly localized pain, effusion and occasionally locking.
- Lesions which are at risk of breaking off (with fluid signal behind them on MRI) may be fixed and loose fragments may require removal.
Appreciate that in kids meniscal tears are more likely to have a chance of healing
Appreciate this
