MSK Flashcards
What are the risk factors for DDH?
female breech >5kg birth weight oligohydramnios family history
What are the signs a baby may have DDH?
- limited abduction
- limb shortening
- asymmetrical gluteal/thigh folds
Name and describe the screening tests for DDH. If they are positive what is done?
Galeazzi: lead supine with hips and knees flexed there is asymmetry in height
Barlow: adduct and push posterior to dislocate
Ortalani: abduct and pull anteriorly to relocate
+ve test = USS hip
When is an USS hip needed for suspected DDH?
+ve screening tests
Positive first degree family history
Still breech at 36 weeks
How is DDH managed?
<6 weeks = wait for spontaneous resolution
>6 weeks = Pavlick harness
What is Perthes disease and in whom does it commonly effect?
AVN of the femoral head affecting boys <8 y/o
What are the signs and symptoms of Perthes disease?
- limited internal rotation and abduction
- may have groin/thigh pain
- limp (antalgic then Trendelenburg)
How is Perthes disease investigated? What is seen?
x-ray hip
- widened joint space
- flattened femoral head
At what age is surgical intervention indicated for Perthes disease?
> 6 y/o
if younger can just observe
Where (bones and part of bone) does osteomyelitis most commonly affect children?
Distal femur and proximal tibia
Metaphysis
What are the signs and symptoms of osteomyelitis?
Fever and systemically unwell
Limp
Pain exacerbated by movement
Tender, erythematous and swollen
What is the stepwise management of osteomyelitis?
- 72 hours of IV flucloxacillin
2. surgical debridement and 6 weeks oral flucloxacillin
Which joint is most commonly affected by septic arthritis in children?
Hip
What are the signs and symptoms of septic arthritis?
Fever and systemically unwell
Pain on passive movement
Limp
Swollen, hot joint
How is septic arthritis investigated and managed?
Joint aspirate to examine synovial fluid
MRI
Surgical drainage and IV flucloxacillin
What are the signs and symptoms of transient synovitis?
Post viral infection: Limp Pain on active movement Pain on passive movement ONLY at extreme ROM Low grade fever
How is transient synovitis investigated and what may be seen?
x-ray frog, lateral and AP: widened joint space
What are the signs and symptoms of juvenile idiopathic arthritis?
- Arthritis for >6 weeks
- Salmon pink rash
- Lymphadenopathy
- Low grade fever
What antibody is seen in juvenile idiopathic arthritis?
ANA
What are the red flags of a limping child?
- <3 years old (probably not transient synovitis)
- Fever
- Unable to weight bear
- Neurovascular compromise
- Night pain
- Weight loss
What is Rickets?
Decreased mineralisation of the bone before closure of the growth plates
What are the risk factors for developing Rickets?
- Non Caucasian
- Antiepileptics
- Vegetarian
- Exclusively breast fed >6 months
- IBD, coeliac, CF
What are the signs of Rickets?
- Delayed closure of fontanelles
- Frontal bossing
- Dental hypoplasia
- Swollen ankles and wrists
- Bowing of the legs
- Pectus carinatum
- Rachitic rosary
How is Rickets investigated and what is seen?
X-ray wrist: metaphyseal cupping, splaying, fraying
Describe growing pains
- Bilateral
- Worse on activity and NOT on waking
- Intermittent
The child is systemically well with a normal examination and no limitations to activity
In whom and how does SUFE present?
Obese teenagers:
- limp
- hip pain radiating to knee
- limited abduction and internal rotation
How is SUFE investigated and what is seen?
Hip x-ray frog leg and AP shows femoral head slipping inferolateral (ice cream cone melting)
How is SUFE managed?
Non-weight bearing
May require pinning if AVN risk
What are the symptoms of Ewing’s sarcoma and what is seen on x-ray?
Pain in the pelvis and long bones
X-ray: lytic lesion of the diaphysis with an onion skin appearance
What is osteochondroma?
Benign cartilage capped bony projections on the surface of the bone
Where does osteosarcomas affect and therefore how does it present?
Metaphysis of long bones prior to growth plate closure.
Presents as pain and swelling at the site
Describe the x-ray of an osteosarcoma
Sunburst lesion
