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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
How might a patient with slipped upper femoral epiphysis present
Hip, groin, thigh, or knee pain Restricted range of hip movement Painful limp Restricted movement Keeping hip externally rotated (limited internal rotation)
26
What are the investigations for slipped upper femoral epiphysis
X-ray Blood Technetium bone scan CT/MRI
27
What is the management for slipped upper femoral epiphysis
Surgery (return femoral head to correct position, fix in place)
28
What is osteomyelitis
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
What are the risk factors for osteomyelitis
Open bone fracture Orthopaedic surgery Immunocompromised Sickle cell anaemia HIV TB
30
How might a patient with osteomyelitis present
Refusal to use limb Refusal to weight bear Pain Swelling Tenderness Possible fever
31
What are the investigations for osteomyelitis
X-ray MRI Bloods (high inflammatory markers, high white cell count) Blood culture Bone marrow aspiration Bone biopsy
32
What is the management for osteomyelitis
Antibiotics (extensive and prolonged) May need drainage and debridement
33
What is osteosarcoma
Bone cancer Usually in 10-20s Most commonly affects: femur, tibia, humerus
34
How might a patient with osteosarcoma present
Persistent bone pain Waking from sleep Bone swelling Palpable mass Restricted joint movement
35
What are the investigations for osteosarcome
Very urgent direct access X-ray (within 48 hours) Bloods (possible raised ALP) Staging CT/MRI/PET/bone biopsy
36
What are the X-ray signs of osteosarcoma
Poorly defined lesion in bone Destruction of normal bone Fluffy appearance Periosteal reaction
37
What is the management for osteosarcoma
Surgical resection (often needs amputation) Adjuvant chemotherapy MDT input
38
What are the complications of osteosarcoma
Pathological bone fractures Metastasis
39
What is talipes
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
What is the management for talipes
Ponseti method (immediately after birth, repeated foot positioning with a cast, use a brace when not walking when older) Surgery
41
What is developmental dysplasia of the kip
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
How might a patient with developmental dysplasia of the hip present
Newborn examination Hip asymmetry Reduced range of movement Limp
43
What are the risk factors for developmental dysplasia of the hip
1st degree family member Breech presentation from 36 weeks onwards Breech presentation at birth if 28 weeks onwards Multiple pregnancy
44
What are the investigations for developmental dysplasia of the hip
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
What is the management for developmental dysplasia of the hip
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
What is rickets
Defective bone mineralisation Causes soft and deformed bones
47
What are the causes of rickets
Vitamin D deficiency Calcium deficiency
48
How might a patient with rickets present
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
What are the investigations for rickets
Serum vitamin D, calcium, phosphate, ALP, PTH X-ray
50
What is the management for rickets
Prevention Breastfed babies at risk of vitamin D deficiency (take supplements) Calcium and vitamin D supplements
51
What is achondroplasia
Most common cause of disproportionate short stature A type of skeletal dysplasia Autosomal dominant Abnormal function of epiphyseal plates
52
What is achondroplasia associated with
Recurrent otitis media Kyphoscoliosis Spinal stenosis Obstructive sleep apnoea Obesity Cervical cord compression Hydrocephalus
53
How might a patient with achondroplasia present
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
What is the management for achondroplasia
MDT input Leg length surgery
55
What is Osgood-Schlatter disease
Inflammation at tibial tuberosity (where patella ligament inserts) Mostly in 10-15s More common in boys Usually unilateral
56
How might a patient with Osgood-Schlatter disease present
Gradual onset Visible or palpable hard and tender lump at tibial tuberosity Pain in anterior knee Exacerbated by: activity, kneeling, extension
57
What is the management for Osgood-Schlatter disease
Reduce physical activity Ice NSAIDs Stretching and physio
58
What is the prognosis for Osgood-Schlatter disease
Spontaneously resolves over time Left with hard bony lump Can get avulsion fractures (tibial tuberosity separated from rest of tibia)
59
What is osteogenesis imperfecta
Brittle bones Prone to fractures Genetic mutation affecting formation of collagen
60
How might a patient with osteogenesis imperfecta present
Hypermobility Blue/grey sclera Triangular face Short stature Deafness from early adulthood Dental problems Bowed legs Scoliosis Joint and bone pain
61
What is the management for osteogenesis imperfecta
Clinical diagnosis X-ray Bisphosphonates Vitamin D supplements

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