MSK Paediatrics Flashcards
differentials for limping child 7
transient synovitis
septic arthritis/ osteomyelitis
Juvenile idiopathic arthritis
trauma
Development dysplasia of the hips
Perthes disease
Slipped upper femoral epiphysis
presentation of transient synovitis 3
-age
-gender bias
acute onset
usually accompanies viral infections
-but child is well or has mild fever
most common in boys, age 2-12
presenation of septic arthritis/osteomyeltis 2
unwell child
high fever
presentation of juvenile idiopathic arthritis 1
limp but may be painless
whats vital when assessing trauma in limping child
history usually diagnostic
presentaion of development dysplasia of the hip 1
-gender bias
usually detected in neonates
6x more common in girls
presentation of perthes disease
-age?
more common 4-8yo
due to AVN of femoral head
presentatino of slipped upper femoral epiphysis
-age?
10-15 yo
displacemnt of femoral head epiphysis postero-inferiorly
most common primary tumours of bone 2
osteosarcoma
Ewings
difference between fractures in adults and children 4
fracture patterns
time to healing
remodelling
treatment differs
fracture pattern in children compared to adults
buckle fractues
plastic deformation
greenstick fractures
-occur in children but not adults
-becuase mechanical property of immature bone is different
-in mechanical terms a child bone is less brittle
time to healing of fractures in children compared to adults
femoral fracturs heal in ‘age in years+1’ weeks
physeal fractures heal in 2-3wks
adult fractures heal much slower
remodelling of fractures in children compared to adults
proximal humeral fractures remodel well
-rotational deormites of any fracture do not remodel
how does treatment of fractures inchildren differ to adults
rational for surgical fracature treatment in adults is often due to complications of immobility (osteoporosis, pressure sores, UTI, DVT, confusion)
these are very rare in children
-thereofre fracture treatment relies more on plaster casts and percutaneous fixation with fine wires
common fractures in child 2
distal forearm and wrist injuries
which fracture in children is of particular consideration and why
supracondylar distal humeral fracture
-associated with major nerves and blood vessels of the upper arm like the brachial artery and anterior intraosseous
why are physes fractures of importance in fractures of children
partial growth arrest can occur and result in angular deformity, lower-extremity limb-length discrepancy, incongruity of the joint surface, or a combination of these
describe the salter harris classification system
used to grade fractures that occur in children and ilvovle the growth plate [70]
regarding the salter harris classification system
define type 1
transverse fracture thorugh growth plate [70]
regarding the salter harris classification system
define type 2
fracture through growth plate+ metaphysis but not epiphysis [70]
regarding the salter harris classification system
define type 3
fracture through growthplate+ epiphyssi but not metaphysis [70]
regarding the salter harris classification system
define type 4
fracture through growth plate + epiphysis+ metaphysis [70]
regarding the salter harris classification system
define type 5
compressure gracture of grwoth plate
-results in decreased perceived space between epiphysis and metaphysics on XR [70]
define clubfoot
talpised equinovarus
-described as inverted (inward turning) and plantar flexed sfoot
usually diagnosed on newborn exam
what is the nature of the clubfoot deformity 4
use mneonmic CAVE
-Cavus
-Adductus
-Varus
-Equinuus
associations for clubfoot 6
most commonly idiopathic
assoc:
-spina bifida
-CP
-Edwards syndrome (trisomy 18)
-oligohydramnios
-arthrogryposis
diagnosis of clubfoot
usually clinical
-deformity not passively correctable
imaging not normally needed
management of clubfoot 1
now ponseti method preferred over surgery
describe the ponseti method for clubfoot 4
-manipulation and progressive casting which starts soon after birth
-deformity is usually corrected after 6-10wks
-achilles tentoomy usually required (can be done under LA)
-night time braces applied until 4yo
spectrum of nomral conditions in children that are normal variants 3
flat foot
in toeing
genu varum/valgus (bow leg, knock knee)
red flags for non-accidental injury 3
serial bruising
atypical injuries for age of child
inconsistent history
