Ortho

Question 1

What is Septic Arthritis?

Answer 1

A joint infection common in children <4y

Question 2

How does Septic Arthritis present?

Answer 2

Unilateral, commonly hip/knee
Hot, red, swollen and painful joint
Refusal to WB
Stiffness
Reduced ROM
Fever
Lethargy
Sepsis

Question 3

Which organisms can be responsible for septic arthritis?

Answer 3

Staph Aureus - Most common
Neisseria Gonorrhoea
Group A Strep
H.Influenzae
E.Coli

Question 4

What are some important differentials for suspected septic arthritis?

Answer 4

Transient Synovitis
Perthes disease
SUFE
JIA

Question 5

Once confirmed, how should septic arthritis be managed?

Answer 5

Joint aspirate for culture, gram stain and micro
Empirical IV Abx for 3-6w
Surgical Washout and Drainage if severe

Question 6

What is Transient Synovitis?

Answer 6

Temporary inflammation of the synovial membrane of a joint

Question 7

What is transient synovitis commonly associated with?

Answer 7

Viral URTI

Question 8

When does transient synovitis typically present?

Answer 8

3-10y

Question 9

What are some symptoms of transient synovitis?

Answer 9

Limp
Refusal to WB
Groin/Hip pain
Mild low-grade fever
Systemically well

Question 10

How can transient synovitis be managed?

Answer 10

Supportive - Analgesia

Can be managed in primary care if systemically well and Sx <48h.

Question 11

What is Perthes disease?

Answer 11

Avascular necrosis of the femoral head affecting the epiphysis

Question 12

When does Perthes present?

Answer 12

4-12y

Question 13

What is the cause of Perthes disease?

Answer 13

Idiopathic

Question 14

What are some symptoms of Perthes disease?

Answer 14

Slow onset of:
Hip/Groin pain
Limp
Restricted movements 
Referred knee pain

Question 15

What is important in the history of Perthes disease?

Answer 15

No trauma prior to presentation

Question 16

Which investigations are appropriate in suspected Perthes?

Answer 16

XR
Bloods - Usually normal
Technetium
MRI

Question 17

How can mild Perthes be managed?

Answer 17

Conservative - Bed rest, traction, crutches, analgesia

Question 18

How should severe Perthes be managed?

Answer 18

Surgical alignment

Question 19

What is a SUFE?

Answer 19

Head of femur displaces along the growth plate

Question 20

When is a SUFE most common?

Answer 20

8-15y, more common in obese children

Question 21

What is a typical presentation of a SUFE?

Answer 21

Adolescent Obese child undergoing a growth spurt with a history of minor trauma

Question 22

What are some symptoms of a SUFE?

Answer 22

Hip, groin, thigh or knee pain
Reduced range of movement
Painful limp
Restricted movement in the hip
Patient prefers to keep hip externally rotated

Question 23

Which investigations are appropriate for a suspected SUFE?

Answer 23

XR
Bloods
Technetium bone scan
MRI

Question 24

How is a confirmed SUFE managed?

Answer 24

Surgical fixation

Question 25

What is DDH?

Answer 25

Structural abnormality in the hips caused by abnormal development during pregnancy. This leaves the hip unstable and vulnerable to dislocation

Question 26

What are some risk factors for DDH?

Answer 26

1st degree family history
Breech presentation >28w
Multiple pregnancy

Question 27

What are some sings of DDH?

Answer 27

Different leg lengths
Restricted Hip Abduction on one side
Bilateral restriction of abduction

Question 28

Which NIPE tests are positive in DDH?

Answer 28

Barlow

Ortolani

Question 29

How should suspected DDH be investigated?

Answer 29

USS

Question 30

How should confirmed DDH be managed?

Answer 30

<6m - Pavlik harness

>6m - Surgical Fixation + Hip Spica