Musculoskeletal Flashcards
What is the likely Dx for a teenage girl that has anterior knee pain that is worse on rising after prolonged sitting, and when going up and down stairs?
Chondromalacia patellae
What is the likely Dx when a child has medial knee pain and their knee occasionally gives way?
Patellar subluxation
What is the likely Dx when a child has pain in their knee after exercise and their knee tends to lock?
Osteochondritis dissecans
Where is the tenderness in Osgood-Schlatter disease?
Tibial tubercle
What are the RFs for DDH?
- F
- Breech
- FHx
- First-born
- BW >5kg
- Oligohydramnios
In which hip is DDH more common?
L hip
By what age will DDH probably stabilise?
3-6 weeks of age
What are the features of a HxPC of growing pains?
- Never present on waking
- No limp
- No limitation of movement
- Systemically well
- Normal O/E
- Motor milestones normal
- Sx worse after a day of activity
What are the possible causes of a painful limb?
- Osteomyelitis
- Septic arthritis
- Fracture
- Sickle cell disease
- Bone tumours
Where is the infection in osteomyelitis?
Metaphysis of long bones
What are the most common sites of osteomyelitis?
- Proximal tibia
2. Distal femur
How does osteomyelitis usually spread?
Haematogenous spread
What are the causative pathogens of osteomyelitis?
- S.aureus (mostly)
- Streptococcus
- H.influenzae
What are the different fracture patterns?
- Plastic deformation (not technically a fracture)
- Buckle fracture
- Greenstick frature
- Complete fracture
Whom gets plastic deformations?
Children, unique to them - bone angulated beyond elastic limit, but energy insufficient to cause a fracture
In what bones may plastic deformations be seen?
Ulna, occasionally fibula
Where are buckle fractures most commonly seen?
At the junction of the metaphysis and the diaphysis in the distal radius, usually caused by fall on an out-stretched hand
What are the different types of complete fracture?
Spiral - created by rotational force
Transverse
Oblique
How are physeal fractures classified?
Salter-Harris (SH) classification
What is a SH Class I physeal fracture?
Transverse fracture through the growth plate, the epiphysis seperating from the metaphysis
What is the most common SH classification of a physeal fracture?
SH Class II
What is a SH Class II fracture?
Transverse fracture through the growth plate and an oblique or vertical fracture through the metaphysis
What is a SH Class III fracture?
Transverse fracture through the growth plate and a vertical fracture through the epiphysis
What is a SH Class IV fracture?
Vertical fracture through the metaphysis, physis and epiphysis
What is a SH Class V fracture?
Compression/crushing fracture of the growth plate
What are the complications of physeal injury?
Majority heal quickly and recover fully. BUT may cause growth disturbance/arrest, which can then result in deformity and impaired function
What are the common causes of paediatric fractures?
- Child abuse
- Birth injury
- Rickets
- Osteomyelitis
- Copper deficiency
What are the differentials for a limping child?
- Transient synovitis
- CDH
- Perthes disease
- SCFE
What does SCFE stand for?
Slipped capital femoral epiphyses
What is the most common cause of acute hip pain in children?
Transient synovitis
What is the HxPC of transient synovitis?
- Accompanies/follows viral infection frequently
- Sudden onset
- No pain at rest
- Reduced ROM, esp. internal rotation
- Pain may be referred to the knee
What is Perthes disease?
Avascular necrosis of the capital femoral epiphysis
What is SCFE?
Displacement of the epiphysis of the femoral head posterio-inferiorly
When is SCFE most common?
During the adolescent growth spurt, esp. in obese boys
What is the most common causative organism of septic arthritis?
S.aureus (beyond the neonatal period)
What are the complications of juvenile idiopathic arthritis (JIA)?
- Chronic anterior uveitis
- Flexion contracture of the joints
- Growth failure
- Constitutional problems - e.g. anaemia of chronic disease/delayed puberty
- Osteoporosis
- Amyloidosis
