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MD 3 - Paeds > Orthopaedic > Flashcards

Orthopaedic Flashcards

1
Q

most common age for transient synovitis

A

3-8 years

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2
Q

mechanism of action for a supracondylar #

A

FOOSH with hyperextension at the elbow

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3
Q

which deformity can result from an incorrectly managed supraconylar #

A

cubits varus

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4
Q

most common Dx of limp in:

  • Pre-school
  • primary school
  • adolescence
A

preschool - transient synovitis
primary school - Perthes disease
adolescence - SUFE

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5
Q

asymmetrical pigeon toeing is indicative of

A

a spiral fracture in toddlers

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6
Q

which conditions MUST you rule out in a children with a limp

A

malignancy
infection - septic arthritis/osteomyelitis
NAI

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7
Q

complications of no treatment of DDH

A

pain
early high OA
limp
difficulty walking

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8
Q

when should tests on the hips be performed in children

A

birth
1,2,4, 8 weeks
4, 8 months

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9
Q

how do you diagnose SUFE

A

XRay

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10
Q

what are the tests used for looking for DDH in a child >4 weeks

A
  • decreased abduction
  • skin creases
  • thigh length discrepancy
  • Knee height discrepancy
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11
Q

empirical AB choice for septic arthritis/osteomyelitis

A

Flucloxacillin

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12
Q

risk factors for DDH

A
  • breach delivery
  • oligohydramnios
  • C. section
  • FHx
  • Congenital abnormalities (especially foot abnormalities)
  • first-born
  • female
  • large baby
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13
Q

clinical presentation of transient synovitis

A
  • limp
  • unilateral hip or groin pain
  • history of recent URTI
  • otherwise well child
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14
Q

clinical presentation of perthes disease

A
  • limp, especially after exercise

- mild or intermittent pain in anterior thigh (but classically described as a painless limp)

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15
Q

treatment of a Toddler’s fracture

A

needs to treatment - heals spontaneously

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16
Q

what is perthes disease

A

idiopathic avascular necrosis of the capital femoral epiphysis resulting from compromise of the blood supply

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17
Q

what causes DDH

A

failure of the hip joint to develop normally –> dislocation of the hip

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18
Q

most common mechanism of action leading to a Monteggia fracture-dislocation

A

FOOSH with hyperpronation or hyperextension of the forearm

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19
Q

fancy name for flat feet

A

pes planus

20
Q

what is transient synovitis

A

transient inflammation of the synovium of the hip

21
Q

what are the tests used for looking for DDH in a child

A

Barlow - (downwards)

Otolani - (abduction)

22
Q

DDx for limping/non-weight bearing child of age 1-4

A

DDH
toddler’s #
Transient synovitis of the hip - most common
child abuse

23
Q

how long is the typical oral AB course for septic arthritis/osteomyelitis (after completion of IV therapy)

A

3 weeks if uncomplicated

24
Q

what is sitting in a W position indicative of

A

inset hips

25
Q

common risk factors for SUFE

A
  • OBESITY
  • boys>girls
  • L>R
26
Q

most common bacterial causes of septic arthritis/osteomyelitis

A

staph aureus
group A b-haemolytic strep
haemophilus influenza

27
Q

DDx for limping/non-weight bearing child of age 4-10 years

A

transient synovitis of the hip

Perthes disease

28
Q

treatment of transient synovitis

A

heat and massage

ibuprofen

29
Q

what is the difference in pain onset between osteomyelitis and septic arthritis

A

osteomyelitis is usually a subacute onset, whereas SA is acute

30
Q

what is a Toddler’s fracture

A

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

31
Q

common age of patients with SUFE

A

late childhood/early adolescence

32
Q

what is the difference between a greenstick fracture and a torus fracture

A

greenstick - fracture is on the outside corner of the bend

torus - fracture is on the inside corner of the bend

33
Q

mechanism of action of a Toddler’s fracture

A

twisting injury

34
Q

what does SUFE stand for

A

slipped upper femoral epiphysis

35
Q

what is the tip toe test

A
  • diagnoses flat feet

- when child on tip toes, the long flexor and extensor muscles are recruited in the foot and an arch appears

36
Q

what signs on examination point you towards transient synovitis

A
  • decreased range of hip movement - especially internal rotation
  • may be tender to palpation
37
Q

age range for perthes disease

A

2-12

majority 4-8

38
Q

principles of management of perthes disease

A

minimal weight bearing and protection of the joint (maintain the femur abducted and internally rotated using a brace or surgery

39
Q

what signs on examination point you towards perthes disease

A
  • restricted hip motion, especially in abduction and internal rotation
  • proximal thigh atrophy
40
Q

DDx for limping/non-weight bearing child of age >10

A
  • slipped upper femoral epiphysis

- overuse syndromes/stress fractures

41
Q

diagnosis of DDH is done by which imaging

A

US - if 6 months

42
Q

management of DDH

A
  • 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
43
Q

what causes Volkmann’s ischaemic contracture and what is a common # it results from

A

disruption to the brachial artery –> necrosis of the muscles of the forearm
- commonly results from a supracondylar # with forward displacement of the metaphysis

44
Q

pathological causes of flat feet

A

hypermobility syndromes

CP

45
Q

principles of management of SUFE

A

SURGERY - immediate internal fixation in-situ

46
Q

what features on examination point you towards SUFE

A
  • hip appears externally rotated and shortened

- decreased hip movement, especially internal rotation

47
Q

potential complications of untreated SUFE

A

chondrolysis of the hip

avascular necrosis

MD 3 - Paeds (18 decks)

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