MSK problems in childhood Flashcards
How is a child’s periosteum different to an adult’s?
thicker and more vascular than adults
- greater osteogenic potential
- helps healing + remodelling
often remains intact despite bone injury
What is a torus fracture?
buckle fracture
compression injury
stable
treat symptomatically
What classification is used to grade growth plate fractures?
salter-harris
Pathological causes of leg malalignment in children (valgus/varus deformities)
valgus or varus:
physiologic
rickets
skeletal dysplasias
trauma/infection
varus:
blount disease
What is blount disease?
persistent, progressive bowleg deformity
aetiology unknown
Associations of blount disease
obesity
early walkers
afro-caribbean origin
family history
What is metatarsus adductus and how is it managed?
medial deviation of the forefoot
usually managed with stretching exercises or plasters
Characteristics of growing pains
3-12 years old
aches and pains poorly localised in lower limbs - calves, shins, ankles
usually bilateral
night waking - intermittent, often predictable related to activity
never pain on waking in the morning
no limp
systemically well
What is Osgood-Schlatter disease?
traction of apophysitis of tibial tuberosity
localised pain and swelling
clinical diagnosis
self-limiting
10-15y, usually boys
Osgood-Schlatter disease management
activity modification
physio
Another name for idiopathic anterior knee pain
chrondromalacia patellae
Describe chondromalacia patellae
activity related to pain over anterior knee
patella instability/locking
usually resolves spontaneously
Chrondromalacia patellae treatment
physio
orthotics
activity modification
SUFE symptoms
pain
- activity related
- hips
- could be just thigh or knee
limp
- antalgic
- externally rotated limb
SUFE AP pelvis signs
physeal widening
Trethowan’s sign
reduced epiphyseal height
SUFE management
pin in situ
femoral osteotomy to reshape femur
or open reduction
DDH risk factors
females
first born
family history
breech
oligohydramnios
packaging disorders
Spectrum of abnormality in DDH
dysplasia
subluxation
dislocation
instability
DDH presentation
screening:
- clinical examination
- risk-factor mediated USS
limping child
leg length discrepancy
Examination findings in DDH
leg length discrepancy (Galeazzi)
asymmetric thigh skin creases
restricted range of motion -
Barlow + Ortolani (less sensitive with increasing age as structures stiffen)
What is Allis test?
looking for skin fold asymmetry in suspected DDH
What is Galeazzi test?
looking for leg length discrepancy - helps you assess if tibial or femoral
Which babies get USS screening for DDH?
breech after 36 weeks
FH 1st degree relative hip disorder in early childhood
abnormal clinical examination
DDH management
guided by age
Pavlik harness - harnesses natural remodelling
Closed reduction, with tenotomies, with hip spica
Open reduction with hip spica
Open reduction, femoral/pelvic osteotomy, spica
How can DDH present late
leg length discrepancy
restricted range of movement (particularly abduction of flexed hip)
abnormal gait
What is Perthes disease?
idiopathic avascular necrosis of femoral head
Perthes presentation/signs
stiff hip - particularly abduction
pain
limp
leg length discrepancy
Clubfoot proper name
congenital talipes equinovarus
Describe clubfoot deformity
congenital foot deformity:
- cavus midfoot
- adduction of midfoot and forefoot
- varus subtalar joint
- equinus of hindfoot
Clubfoot management
Ponseti method
serial weekly plasters
achilles tenotomy
then boots and bars
