Locomotor system Flashcards
What is the definitive investigation in suspected septic arthritis?
Aspiration of the joint space under US guidance for organisms and culture
Why is Developmental Dysplasia of the Hip not always detected at birth?
DDH is an ongoing developmental process with a spectrum of severity from mild acetabular dysplasia with a stable hip through to established hip dysplasia with or withour subluxation/dislocation.
Anatomically, what is the cause of DDH?
A shallow actebulum which does not adequately cover the femoral head - easily dislocated.
Is DDH more common in males or females?
Females are 6 times more likely to get it than males.
Other risk factors include prematurity, family history, first born, multiple pregnancy
What tests are used to help detect DDH?
Barlow’s test: adducts hip and applies posterior force, dislocating the hip (clunk heard)
Ortalani’s test: abducts hip and applies anterior force to reduce the hip
How is DDH managed?
Babies with risk factors for DDH or abnormal examination should have US hip < 12 weeks.
Actively treat if hip still unstable by 6-8 weeks as spontaneous resolution less likely by this point.
0-6 months of age: Bracing with Pavlik harness for several months
Over 6 months: surgical correction
How long after gastroenteritis/viral URTI in young children does transient synovitis/reactive arthritis/irritable hip typically occur?
7-10 days after the viral infection
How can a joint aspirate differentiate between septic arthritis and transient synovitis?
Joint aspirate will be clear in transient synovitis but will be pus-filled in septic arthritis
What criteria must be fulfilled for a diagnosis of juvenile idiopathic arthritis?
Diagnosis of exclusion.
Onset before 16th birthday. At least 6 weeks of joint swelling. Limited range of movement. Tenderness/pain of joint.
In Juvenile Idiopathic Arthritis, if ANA comes back as postive, what is the patient at high risk of?
Posterior uveitis
so regular eye screening
How is JIA managed?
1st line: NSAIDs/intra-articular steroids to reduce inflammation
2nd line: DMARDs e.g. methotrexate
What is Perthe’s disease?
Loss of blood supply to the femoral head (avascular necrosis), which leads to abnormal growth of the epiphysis and bone remodelling. Typically occurs in boys aged 4-8.
How is Perthe’s disease managed?
If aged < 8 or bone age < 6: Conservative management with physio and strengthening.
Age > 8 or > 50% necrosis: Consider surgery.
How is Slipped Upper Femoral Epiphysis managed?
Orthopaedic emergency.
Patient must not walk - immediate bedrest. Provide analgesia. Urgent surgical closure of epiphysis with percutaneous screws.
