Ortho Flashcards
What is Septic Arthritis?
A joint infection common in children <4y
How does Septic Arthritis present?
Unilateral, commonly hip/knee Hot, red, swollen and painful joint Refusal to WB Stiffness Reduced ROM Fever Lethargy Sepsis
Which organisms can be responsible for septic arthritis?
Staph Aureus - Most common Neisseria Gonorrhoea Group A Strep H.Influenzae E.Coli
What are some important differentials for suspected septic arthritis?
Transient Synovitis
Perthes disease
SUFE
JIA
Once confirmed, how should septic arthritis be managed?
Joint aspirate for culture, gram stain and micro
Empirical IV Abx for 3-6w
Surgical Washout and Drainage if severe
What is Transient Synovitis?
Temporary inflammation of the synovial membrane of a joint
What is transient synovitis commonly associated with?
Viral URTI
When does transient synovitis typically present?
3-10y
What are some symptoms of transient synovitis?
Limp Refusal to WB Groin/Hip pain Mild low-grade fever Systemically well
How can transient synovitis be managed?
Supportive - Analgesia
Can be managed in primary care if systemically well and Sx <48h.
What is Perthes disease?
Avascular necrosis of the femoral head affecting the epiphysis
When does Perthes present?
4-12y
What is the cause of Perthes disease?
Idiopathic
What are some symptoms of Perthes disease?
Slow onset of: Hip/Groin pain Limp Restricted movements Referred knee pain
What is important in the history of Perthes disease?
No trauma prior to presentation
Which investigations are appropriate in suspected Perthes?
XR
Bloods - Usually normal
Technetium
MRI
How can mild Perthes be managed?
Conservative - Bed rest, traction, crutches, analgesia
How should severe Perthes be managed?
Surgical alignment
What is a SUFE?
Head of femur displaces along the growth plate
When is a SUFE most common?
8-15y, more common in obese children
What is a typical presentation of a SUFE?
Adolescent Obese child undergoing a growth spurt with a history of minor trauma
What are some symptoms of a SUFE?
Hip, groin, thigh or knee pain Reduced range of movement Painful limp Restricted movement in the hip Patient prefers to keep hip externally rotated
Which investigations are appropriate for a suspected SUFE?
XR
Bloods
Technetium bone scan
MRI
How is a confirmed SUFE managed?
Surgical fixation
What is DDH?
Structural abnormality in the hips caused by abnormal development during pregnancy. This leaves the hip unstable and vulnerable to dislocation
What are some risk factors for DDH?
1st degree family history
Breech presentation >28w
Multiple pregnancy
What are some sings of DDH?
Different leg lengths
Restricted Hip Abduction on one side
Bilateral restriction of abduction
Which NIPE tests are positive in DDH?
Barlow
Ortolani
How should suspected DDH be investigated?
USS
How should confirmed DDH be managed?
<6m - Pavlik harness
>6m - Surgical Fixation + Hip Spica
