Orthopaedic Flashcards
most common age for transient synovitis
3-8 years
mechanism of action for a supracondylar #
FOOSH with hyperextension at the elbow
which deformity can result from an incorrectly managed supraconylar #
cubits varus
most common Dx of limp in:
- Pre-school
- primary school
- adolescence
preschool - transient synovitis
primary school - Perthes disease
adolescence - SUFE
asymmetrical pigeon toeing is indicative of
a spiral fracture in toddlers
which conditions MUST you rule out in a children with a limp
malignancy
infection - septic arthritis/osteomyelitis
NAI
complications of no treatment of DDH
pain
early high OA
limp
difficulty walking
when should tests on the hips be performed in children
birth
1,2,4, 8 weeks
4, 8 months
how do you diagnose SUFE
XRay
what are the tests used for looking for DDH in a child >4 weeks
- decreased abduction
- skin creases
- thigh length discrepancy
- Knee height discrepancy
empirical AB choice for septic arthritis/osteomyelitis
Flucloxacillin
risk factors for DDH
- breach delivery
- oligohydramnios
- C. section
- FHx
- Congenital abnormalities (especially foot abnormalities)
- first-born
- female
- large baby
clinical presentation of transient synovitis
- limp
- unilateral hip or groin pain
- history of recent URTI
- otherwise well child
clinical presentation of perthes disease
- limp, especially after exercise
- mild or intermittent pain in anterior thigh (but classically described as a painless limp)
treatment of a Toddler’s fracture
needs to treatment - heals spontaneously
what is perthes disease
idiopathic avascular necrosis of the capital femoral epiphysis resulting from compromise of the blood supply
what causes DDH
failure of the hip joint to develop normally –> dislocation of the hip
most common mechanism of action leading to a Monteggia fracture-dislocation
FOOSH with hyperpronation or hyperextension of the forearm
fancy name for flat feet
pes planus
what is transient synovitis
transient inflammation of the synovium of the hip
what are the tests used for looking for DDH in a child
Barlow - (downwards)
Otolani - (abduction)
DDx for limping/non-weight bearing child of age 1-4
DDH
toddler’s #
Transient synovitis of the hip - most common
child abuse
how long is the typical oral AB course for septic arthritis/osteomyelitis (after completion of IV therapy)
3 weeks if uncomplicated
what is sitting in a W position indicative of
inset hips
common risk factors for SUFE
- OBESITY
- boys>girls
- L>R
most common bacterial causes of septic arthritis/osteomyelitis
staph aureus
group A b-haemolytic strep
haemophilus influenza
DDx for limping/non-weight bearing child of age 4-10 years
transient synovitis of the hip
Perthes disease
treatment of transient synovitis
heat and massage
ibuprofen
what is the difference in pain onset between osteomyelitis and septic arthritis
osteomyelitis is usually a subacute onset, whereas SA is acute
what is a Toddler’s fracture
type of # of the tibial shaft that occurs in young ambulatory children
- spiral or oblique undisplaced # of the distal shaft of the tibia with an intact fibula
common age of patients with SUFE
late childhood/early adolescence
what is the difference between a greenstick fracture and a torus fracture
greenstick - fracture is on the outside corner of the bend
torus - fracture is on the inside corner of the bend
mechanism of action of a Toddler’s fracture
twisting injury
what does SUFE stand for
slipped upper femoral epiphysis
what is the tip toe test
- diagnoses flat feet
- when child on tip toes, the long flexor and extensor muscles are recruited in the foot and an arch appears
what signs on examination point you towards transient synovitis
- decreased range of hip movement - especially internal rotation
- may be tender to palpation
age range for perthes disease
2-12
majority 4-8
principles of management of perthes disease
minimal weight bearing and protection of the joint (maintain the femur abducted and internally rotated using a brace or surgery
what signs on examination point you towards perthes disease
- restricted hip motion, especially in abduction and internal rotation
- proximal thigh atrophy
DDx for limping/non-weight bearing child of age >10
- slipped upper femoral epiphysis
- overuse syndromes/stress fractures
diagnosis of DDH is done by which imaging
US - if 6 months
management of DDH
- abduction splint - worn until the dysplastic acetabulum is radiologically and clinically normal
- surgery may be needed in a child who is diagnosed later in life
what causes Volkmann’s ischaemic contracture and what is a common # it results from
disruption to the brachial artery –> necrosis of the muscles of the forearm
- commonly results from a supracondylar # with forward displacement of the metaphysis
pathological causes of flat feet
hypermobility syndromes
CP
principles of management of SUFE
SURGERY - immediate internal fixation in-situ
what features on examination point you towards SUFE
- hip appears externally rotated and shortened
- decreased hip movement, especially internal rotation
potential complications of untreated SUFE
chondrolysis of the hip
avascular necrosis
