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Paeds > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What are epiphyseal plates

A

Found in bones of children

Areas at the ends of long bones

Allow bone to grow in length

Made of hyaline cartilage

Usually stronger than the rest of the bone

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2
Q

What are growth plate fractures called, what are the different types

A

Salter-Harris fractures (SALTR)

Type 1: Straight across

Type 2: Above

Type 3: beLow

Type 4: Through

Type 5: cRush

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3
Q

How do children’s bones differ from adult bones

A

More cancellous bone

More flexible

Less strong (get greenstick and buckle fractures)

Have a very good blood supply (fast healing)

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4
Q

What is the management for fractures in children

A

Consider safeguarding

Get mechanical alignment (closed reduction, surgery)

Give stability (cast, K-wires, intramedullary wires, intramedullary nails)

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5
Q

What are the steps of the WHO pain ladder for children

A

Step 1: paracetamol, ibuprofen

Step 2: morphine

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6
Q

How might a patient with hip pain present

A

Limp

Refusal to use leg

Refusal to weight bear

Inability to walk

Pain

Swollen or tender joints

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7
Q

What are the red flags for hip pain

A

< 3 years

Fever

Waking at night with pain

Weight loss

Anorexia

Night sweats

Fatigue

Persistent pain

Stiffness in morning

Swollen or red joint

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8
Q

What are the causes of hip pain in 0-4s

A

Septic arthritis

Developmental dysplasia of the hip

Transient synovitis

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9
Q

What are the causes of hip pain in 5-10s

A

Septic arthritis

Transient synovitis

Perthes disease

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10
Q

What are the causes of hip pain in 10-16s

A

Septic arthritis

Slipped upper femoral epiphysis

Juvenile idiopathic arthritis

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11
Q

What are the criteria for urgent referral for hip pain

A

< 3 years

> 9 with restricted or painful hip

Not able to weight bear

Neurovascular compromise

Severe pain or agitation

Red flags

Suspicion of abuse

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12
Q

What are the investigations for hip pain

A

Bloods (CRP, ESR, JIA (specific to septic arthritis))

X-ray

Ultrasound

Aspiration

MRI (for osteomyelitis)

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13
Q

What is septic arthritis

A

Infection inside a joint

Most common in < 4s

Can destroy joint and cause systemic illness

Common complication of joint replacement

Causative bacteria: staph aureus, neisseria gonorrhoea, group A strep, haemophilus influenzae, E coli

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14
Q

How might a patient with septic arthritis present

A

One single joint affected

Rapid onset

Hot, swollen, red, painful joint

Refusal to weight bear

Stiffness and reduced range of motion

Systemic symptoms

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15
Q

What is the management for septic arthritis

A

Low threshold for treatment until proven otherwise

Admit

Aspirate

Antibiotics (empirical IV, for 3-6 weeks)

Surgical drainage

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16
Q

What is transient synovitis

A

Aka irritable hip

Temporary irritation and inflammation of synovial membrane of hip

Most common cause of hip pain for 3-10s

Linked to recent URTI

Do not usually have fever

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17
Q

How might a patient with transient synovitis present

A

Limp

Refusal to weight bear

Groin or hip pain

Possible mild fever

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18
Q

What is the management for transient synovitis

A

Simple analgesia

Advise to go to A&E if develop fever

Follow up in 48 hours and at 1 week

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19
Q

What is the prognosis for transient synovitis

A

Improved in 24-48 hours

Fully resolves in 1-2 weeks

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20
Q

What is Perthes disease

A

Disruption of blood flow to femoral head

Avascular necrosis of bone

Usually in 5-8s

More common in boys

Idiopathic

Over time: revascularisation and healing, remodelling of bone

Can lead to early osteoarthritis

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21
Q

How might a patient with Perthes disease present

A

Slow onset

Pain in hip or groin

Limp

Restricted hip movement

Referred pain to knee

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22
Q

What are the investigations for Perthes disease

A

X-ray

Bloods

Technetium bone scan

MRI

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23
Q

What is the management for Perthes disease

A

Conservative (bed rest, traction, crutched, analgesia)

Physio

Regular X-ray (assess healing)

Surgery if: severe, older child, not healing

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24
Q

What is slipped upper femoral epiphysis

A

Aka SUFE

Head of femur displaced along growth plate

More common in boys

Usually 8-15s (slightly earlier in girls)

More common in obese children

Suspect when pain disproportionate to trauma

Usually during a growth spurt

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25
Q

How might a patient with slipped upper femoral epiphysis present

A

Hip, groin, thigh, or knee pain

Restricted range of hip movement

Painful limp

Restricted movement

Keeping hip externally rotated (limited internal rotation)

26
Q

What are the investigations for slipped upper femoral epiphysis

A

X-ray

Blood

Technetium bone scan

CT/MRI

27
Q

What is the management for slipped upper femoral epiphysis

A

Surgery (return femoral head to correct position, fix in place)

28
Q

What is osteomyelitis

A

Infection of bone and bone marrow

Usually in metaphysis of long bones

Often due to staph aureus

Chronic: deep seated, slow growing, slow development of symptoms

Acute: develops quickly, acutely unwell child

29
Q

What are the risk factors for osteomyelitis

A

Open bone fracture

Orthopaedic surgery

Immunocompromised

Sickle cell anaemia

HIV

TB

30
Q

How might a patient with osteomyelitis present

A

Refusal to use limb

Refusal to weight bear

Pain

Swelling

Tenderness

Possible fever

31
Q

What are the investigations for osteomyelitis

A

X-ray

MRI

Bloods (high inflammatory markers, high white cell count)

Blood culture

Bone marrow aspiration

Bone biopsy

32
Q

What is the management for osteomyelitis

A

Antibiotics (extensive and prolonged)

May need drainage and debridement

33
Q

What is osteosarcoma

A

Bone cancer

Usually in 10-20s

Most commonly affects: femur, tibia, humerus

34
Q

How might a patient with osteosarcoma present

A

Persistent bone pain

Waking from sleep

Bone swelling

Palpable mass

Restricted joint movement

35
Q

What are the investigations for osteosarcome

A

Very urgent direct access X-ray (within 48 hours)

Bloods (possible raised ALP)

Staging CT/MRI/PET/bone biopsy

36
Q

What are the X-ray signs of osteosarcoma

A

Poorly defined lesion in bone

Destruction of normal bone

Fluffy appearance

Periosteal reaction

37
Q

What is the management for osteosarcoma

A

Surgical resection (often needs amputation)

Adjuvant chemotherapy

MDT input

38
Q

What are the complications of osteosarcoma

A

Pathological bone fractures

Metastasis

39
Q

What is talipes

A

Aka clubfoot

Fixed abnormal ankle position

Talipes equinovarus: ankle in plantar flexion and supination

Talipes calcaneovalgus: ankle in dorsiflexion and pronation

Presents at birth

40
Q

What is the management for talipes

A

Ponseti method (immediately after birth, repeated foot positioning with a cast, use a brace when not walking when older)

Surgery

41
Q

What is developmental dysplasia of the kip

A

Structural abnormality of hip

Instability of joint

Tendency for subluxation and dislocation

If persisting to adulthood, get: weakness, recurrent subluxations/dislocations, abnormal gait, early degenerative changes

42
Q

How might a patient with developmental dysplasia of the hip present

A

Newborn examination

Hip asymmetry

Reduced range of movement

Limp

43
Q

What are the risk factors for developmental dysplasia of the hip

A

1st degree family member

Breech presentation from 36 weeks onwards

Breech presentation at birth if 28 weeks onwards

Multiple pregnancy

44
Q

What are the investigations for developmental dysplasia of the hip

A

Newborn examination: differences in leg length, restricted movement, difference in knee levels when legs flexed, clunking on special tests (Ortolani test (anterior dislocation), Barlow test (posterior dislocation))

Ultrasound

X-ray

45
Q

What is the management for developmental dysplasia of the hip

A

Pavlik harness (if baby < 6 months, keep on permanently for 6-8 weeks, adjust as baby grows, holds femoral head in place so acetabulum can develop)

Surgery (harness fails, diagnosed at > 6 months)

46
Q

What is rickets

A

Defective bone mineralisation

Causes soft and deformed bones

47
Q

What are the causes of rickets

A

Vitamin D deficiency

Calcium deficiency

48
Q

How might a patient with rickets present

A

Lethargy

Bone pain

Swollen wrists

Bone deformity

Poor growth

Dental problems

Muscle weakness

Pathological fractures

Bowing of legs

Knock knees

Rachitic rosary (ends of rips expand, get lumps along chest)

Craniotabes (soft skull, delayed closure of sutures, frontal bossing)

Delayed teeth

49
Q

What are the investigations for rickets

A

Serum vitamin D, calcium, phosphate, ALP, PTH

X-ray

50
Q

What is the management for rickets

A

Prevention

Breastfed babies at risk of vitamin D deficiency (take supplements)

Calcium and vitamin D supplements

51
Q

What is achondroplasia

A

Most common cause of disproportionate short stature

A type of skeletal dysplasia

Autosomal dominant

Abnormal function of epiphyseal plates

52
Q

What is achondroplasia associated with

A

Recurrent otitis media

Kyphoscoliosis

Spinal stenosis

Obstructive sleep apnoea

Obesity

Cervical cord compression

Hydrocephalus

53
Q

How might a patient with achondroplasia present

A

Disproportionate short stature

Average height around 4 feet

Proximal limb bones most affected

Short digits

Bow legs

Disproportionate skull (flattened midface, frontal bossing)

Foramen magnum stenosis

54
Q

What is the management for achondroplasia

A

MDT input

Leg length surgery

55
Q

What is Osgood-Schlatter disease

A

Inflammation at tibial tuberosity (where patella ligament inserts)

Mostly in 10-15s

More common in boys

Usually unilateral

56
Q

How might a patient with Osgood-Schlatter disease present

A

Gradual onset

Visible or palpable hard and tender lump at tibial tuberosity

Pain in anterior knee

Exacerbated by: activity, kneeling, extension

57
Q

What is the management for Osgood-Schlatter disease

A

Reduce physical activity

Ice

NSAIDs

Stretching and physio

58
Q

What is the prognosis for Osgood-Schlatter disease

A

Spontaneously resolves over time

Left with hard bony lump

Can get avulsion fractures (tibial tuberosity separated from rest of tibia)

59
Q

What is osteogenesis imperfecta

A

Brittle bones

Prone to fractures

Genetic mutation affecting formation of collagen

60
Q

How might a patient with osteogenesis imperfecta present

A

Hypermobility

Blue/grey sclera

Triangular face

Short stature

Deafness from early adulthood

Dental problems

Bowed legs

Scoliosis

Joint and bone pain

61
Q

What is the management for osteogenesis imperfecta

A

Clinical diagnosis

X-ray

Bisphosphonates

Vitamin D supplements

Paeds (17 decks)

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