Locomotor

Question 1

Risk factors for Development Dysplasia of the Hip

Answer 1

Breech presentation
Female
FH +ve
Oligohydramnios

Question 2

Examinations for DDH

Answer 2

Barlow’s - dislocates femoral head = BAD

Ortolani’s - relocates the hip = GOOD

Detected with USS/newborn checks

Question 3

Management for DDH

Answer 3

Bracing - pelvic harness

If still unstable at 6 months- surgical

Question 4

Presentation of Transient synovitis

Answer 4

Acute onset hip pain + refusal to weight bear
No pain at rest and child is systemically well
Often follows illness

Child usually aged >3yrs

Question 5

Risk factors for Perthe’s disease

Answer 5

Male
aged 4-8 years
\+ve FH
Low birth weight
caucasian

Question 6

Investigation findings for Perthe’s

Answer 6

early X-rays show joint widening

Late X-rays show femoral head collapse and remodelling

Question 7

Management for Perthe’s

Answer 7

<8yrs = conservative - physio + strengthening exercises

> 8yrs = osteotomy, but dependent on condition of the bone

Question 8

What are the 4 types of SUFE?

Answer 8

1) pre-slip = widening
2) Acute = sudden spontaneous slip
3) Acute-on-chronic = acute pain on chronic slip
4) Chronic = steadily progressive slip

Question 9

Presentation and management of acute slip in SUFE?

Answer 9

Externally rotated, shortened leg
typically affects L left
very painful to the touch, inability to weight bear

Immediate bed rest, analgesia, ortho refer for surgical closure of epiphysis

Question 10

Treatment pathway for suspected Septic Arthritis

Answer 10

1) Synovial fluid aspiration –> Culture + WCC count
- –> then can start Abx
2) baseline bloods - CRP/ESR High, blood culture
3) Abx - typically 2-3 weeks IV fluclox, followed by PO switch for further 2-4 weeks

Imaging of little use

Question 11

What is Reiter’s triad in reactive arthritis

Answer 11

Urethritis
Conjunctivitis
Arthritis

Question 12

Blood results to look for in Reactive arthritis

Answer 12

often HLA-B27 +ve

ESR and CRP will be very high

Question 13

What classifies JIA

Answer 13

Arthritis for at least 6 weeks in a child <16yrs old

Question 14

Management of JIA

Answer 14

Physio, analgesia

Long term - NSAIDS, methotrexate, sulfasalazine

Question 15

Which year groups will likely be affected by which locomotor conditions?

Answer 15

1-3 yrs = Septic arthritis, DDH, Talipes,

3-10 yrs = Perthe’s, transient synovitis

10-16yrs = SUFE, JIA/RA