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1
Q

What is a congenital cause of Osteoporosis on Children

A
  • Osteogenesis Perfecta: Brittle Bone disease
  • Majority AD
  • Inherited disease of Type 1 collagen
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2
Q

What are the signs of Osteogenesis Imperfecta (OI)

A 
Joint laxity and fragility 
Bone Fractures and Deformity 
Low density, BRITTLE, fragile bones
Poor Growth
Bone Pain 
Impaired Mobility 
Deafness, hernias and Valvular Prolapse
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3
Q

What can OI be mistaken for

A

Child abuse

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4
Q

How do you class OI

A

Type 1: mildest and commonest - blue sclerosae and hearing loss
Type 2: lethal form - born with multiple factors and blue sclerae
Type 3: Severe form - Fractures at birth and progressive deformity - blue/white sclerae
Type 4: Moderate form: fragile bones and white sclerae

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5
Q

How do you Ix OI

A

X-ray: many fractures, osteoporotic bones, bowing deformity of long bones
Histology: immature disorganised bone

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6
Q

How do you treat OI

A

Prevent Injury: Physio, Rehab and Occy health
Osteotomy: to correct deformity
Bisphosphates

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7
Q

What is the most common cause of Septic Arthritis and what are its risk factors

A

Staph Aureus - children 2yrs
Strep B - neonates
Neisseria Gonorrhoeae - adolescents

  • Prematurity
  • C-section
  • Invasive procedures
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8
Q

How does septic arthritis present

A
  • Temp and vital signs to exclude haemodynamic instability
  • Localized swelling
  • Effusion, tenderness, warmth
  • Position of comfort – flexion, abduction, and external rotation
  • Severe pain with passive ROM
  • Unwillingness to move joint
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9
Q

What are the 4 prognostic signs for septic arthritis

A 
Kocher Criteria 
- Temp - >38.5
- WCC - > 12
- ESR - > 40 
- Non weightbearing 
(3 or more high chance septic arthritis)
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10
Q

What Ix should you do for septic arthritis

A

Blood Culture +/- US guided Aspiration

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11
Q

Whats is the treatment for septic arthritis and what are complications

A

Urgent surgical drainage and lavage of joint
IV Antibiotics e.g flucloxacillin

operative rarely indicated for Gonorrhoea

Complications; 
Femoral Head destruction 
Deformity 
Joint Contracture 
Limb Length Discrepancy
Gait Abnormalites
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12
Q

What is Transient Synovitis of the Hip

A

Inflammation of the Synovium causing hip pain

May be a mild/absent fever

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13
Q

What is the cause Transient Synovitis

A

Considered to precede a viral illness e.g URTI
OR
Bacterial Infection e.g post strep toxic synovitis
OR
trauma or allergy

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14
Q

How do you examine for Transient Synovitis and what would be found on Ix

A

Pain in extremities of movements

Normal bloods and radiology

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15
Q

What is the treatment for Transient Synovitis

A

Selflimiting usually resolved by 1-2 weeks

Rest and Analgesia

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16
Q

What is Perths Disease

A

Avascular necrosis (caused by lack of blood supply) of the femoral head/epiphysis - leading to bone remodelling distorting the epiphysis/femoral head

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17
Q

What is Perths most common in

A

3 - 11 yr old boys

Cause unknown

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18
Q

How does Perthes Disease present

A
  • Pain in knee and hip causing limp
  • Gait disturbance - antalgic, trendelenburg gait
  • Late finding - limb length discrepancy
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19
Q

What will be found on examination of Perthes Disease

A

Movement of hip limited

Especially internal rotation and abduction

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20
Q

What investigations may be performed in Perthes

A

X- ray and MRI

  • Joint space widening - due to decrease size of femoral head
  • Collapse and Deformity of femoral head
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21
Q

What is the prognosis of Perthes

A

Risk of early onset OA and hip replacement in deformed hip

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22
Q

What is the treatment for Perthes disease

A

Lateral Pillar Classification:
Group A - Height of Lateral Pillar is 100%
Group B - Height of Lateral Pillar is >50%
Group C - Height of Lateral Pillar is <50%

Conservative treatment: limited weight bearing, physical therapy, bed rest and NSAIDS:

  • Young children (< 6y of age) usually do well
  • Lateral pillar A classification
  • Femoral head mostly undamaged
  • Consider casting and bracing before surgery if femoral head deformity develops or range of motion worsens

Surgery: femoral osteotomy
Older children (> 8y of age)
Lateral pillar B/C classification
Extensive damage to the femoral head

  • Group C rarely do well whatever you do!
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23
Q

What is slipped upper femoral epiphysis

A

Displacment through growth plate with epiphysis slipping down and back

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24
Q

What are the risk factors for SUFE

A

Boys
10-16
Obesity
Endocrine Disorders: Hypothyroidism, renal osteodystrophy, GH deficiency

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25
What are the signs of SUFE
Presents after minor injury: Limp - antalgica with externally rotated foot pain in groin, thigh and knee 90% weightbear and 10% cannot
26
What may be seen on examination and X-ray of SUFE
Examination: - Loss of Hip IR, abduction and flexion - obligatory ER during passive flexion X-ray: Anteriorposterior and Frog leg lateral of both hips - widening of joint space, femoral head slipped posteriorly and inferiorly
27
What is the Rx of SUFE
Avoid weight bearing until surgery - Urgent surgical internal fixation with pinning of femoral head - Prophylactic pinning of contralateral hip
28
What are complications of SUFE
Avascular necrosis of femoral head | Early OA
29
What is Rickets
Normal bone density but abnormal mineral content during bone growth
30
What are the S/S of Rickets
- Soft bones - bowed legs, knocked knees - Growth Retardation - Motor Delay - Malaise - Hypotonia - Fractures
31
What are the causes of rickets
Vitamin D deficiency: - malabsorption, - poor diet - lack of sunlight, - maternal Vit D deficiency - breastmilk
32
What Ix may be performed in rickets
plasma: - Vit D deficiency: low 25-(OH)D3 and raised PTH - Alkaline phosphate high - low PO4 and - Ca2+ variable - normal or low X-ray - cupped ragged/frayed metaphyses, bowing of legs
33
How do you Rx rickets
Treat Underlying Problem: | - Give Calciferol (vit D) +/- Calcium (if hypocalcaemia)
34
What are the 3 ways osteomyelitis can occur
1. Direct Innocculation of infection into bones (trauma/surgery) 2. Continuous spread of infection e.g soft tissue and joints 3. Haematogenous seeding - high blood floe in developing bones
35
Where does haematogenous seeding most commonly occur in children
Long bones
36
What are the risk factors for Osteomyeltis
Risk of trusts Vascular supply e.g sickle cell Pre-existing bone/joint problems Immunodeficnency
37
What organism most commonly causes Osteomyelitis
Staph Aureus
38
What organism most commonly causes osteomyelitis in sickle cell and immunocomprimised
SS: Salmonella IC: TB
39
What are the clinical features of Osteomyeltits
Fever Pain gradual onset Local findings: pain, tenderness, warmth and erythema Cortex erosion of bone and exudation of pus Sequata - infected dead bone
40
What may you find on Ix of Osteomyelitis
``` ESR/CRP raised WCC raised Blood culture Bone Biopsy - gold standard X-ray - early changes not visible!! MRI - most sensitive showing inflammation ```
41
What is the treatment of Osteomyelitis
Surgical Debridement | IV Vancomycin and Cefotaxime
42
What is Osofod - Schlotter Disease
Inflammation of the Patellar Ligament at Tibial tuberosity (apophysitis) 90% self limiting
43
Who is OSD common in
10-15 yrs | Sporty boys
44
What are the signs of OSD
Pain below the knee and worse on strenuous exercise
45
What may be found on Ix of OSD
X-ray: tibial tuberosity enlargement +/- fragmentation | MRI - tendonitis
46
What is the treatment for OSD
Limitation of activity, ice and NSAIDS Knee padding and Physiotherapy Tibial Tubercle excision once skeletally mature if all else fails
47
What is discoid Meniscous
Rare anatomical variant usually affecting lateral meniscus of knee
48
How does discoid Meniscous present
Asymptomatic until the meniscus tears causing pain, swelling and snapping
49
What will be found on Ix of Discoid Meiscuc
MRI - thickened meniscal body
50
What is the Rx of Discoid Meniscus
Stretching and strenghting knee muscles | Surgical excision partial or total depending on damage
51
What is developmental dysplasia of the hip (DDH)
Ranges from slight acetabular dysplasia to established hip dislocation
52
What is important about DDH
Early Diagnosis - appropriate realignment can result in good outcome Late diagnosi more complex outcomes
53
When should all babies be assessed for DDH
Hip examination 1st few days and at 6 wks of life
54
What are the signs of DDH
Unequal leg length Shortening Widened Peritoneum and buttock flattening on affected side Skin Crease Asymmetry Delay in walking Limited abduction of hip whilst in flexion
55
What are risk factors for DDH
``` Breech Birth Increased birth weight Oligohydamniosis Older mother Postmaturity Sibling with DDH ```
56
What Examinations and Investigations should be done for DDH
Neonatal Hip tests: Ortolani, Barlow and Galeazzi Manouveres US - in high risk/abnormal exam babies X-ray
57
What is the Rx for DDH
Hips still unstable by 6 wks - Long term splinting in flexion-abduction in Pavlik Harness - 6-18 mths - arthography and closed reduction and period of immobilisation - open reduction If closed techniques fail - After 18mths - Open Reduction
58
What is JIA
Inflammation of the joints that isn't caused by any other condition
59
What is Oligoarthritis
When 4 or fewer joints are affected in first 6 months child may go on to develop arthritis in other joints after 6 months - extended oligoarthritis
60
What is Polyarthritis
5 or more joints affected In first 6 months Two types: - positive RF - negative RF
61
what is enthesitis related Arthritis
Affects joints of legs and spine causing inflammation where tendon attaches bone - stiffness in neck and back
62
What is Psoriatic Arthritis
Can affect any joint but usually the fingers and toes (swollen sausages) with psoriasis a scaly rash
63
What is systemic onset/stills disease JIA
``` Arthritis involving ≥ 1 joint AND intermittent fever that lasts for at least two weeks with fever spikes occurring on at least 3 consecutive days AND ≥ 1 extra-articular manifestation when fever spikes: -pink macular rash on trunk and limbs -Hepatomegaly/Splenomegaly -Lymphadenopathy -Serositits ```
64
What are the signs of JIA
``` Painful, swollen or stiff joints Joints warm to touch Increased tiredness Fever Limp but no injury ```
65
What investigations should be done for JIA
``` Bloods WCC raised ESR/CRP raised RF - in seropositive polyarthritis LFT - raised in systemic ANA raised - oligo, poly and psioratic ``` US and MRI Joint Aspiration - rule out septic arthritis
66
What is the treatment of JIA
MDT approach: PT, OT, dieticians 1st line: NSAIDS low disease activity 2nd: DMARDS in active disease e.g Methotrexate biological therapy e.g Tocilzumab if not responding to DMARDS Systemic Corticosteroids used in short courses in severe disease e.g Prednisalone
67
What should you do if there is knee pain
Think hip!
68
What do growing pains cause
No Limp!!!!!

Paediatrics (13 decks)

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