Orthopaedics Flashcards
Summary of transient synovitis?
Irritable hip
Commonest cause of hip pain in children.
3-8y/o
Acute hip pain following recent viral infection
Limp/ refusal to WB
Low grade fever in minority. ↑ fever, worry of septic arthritis
Self-limiting
Requiring only rest + analgesia.
What is Perthes disease?
Degen condition affecting hip joints of children 4-8yrs
AVN of femoral head, specifically femoral epiphysis
Impaired blood supply causes bone infarction
M>F
Features of Perthes disease?
Hip pain: develops progressively over few wks
Limp
Stiffness + ↓ROM of hip
Catterall staging:
1 (only clinical + histology features)
2 (sclerosis with/ w/o cystic changes articular surface preserved),
3(loss of structural integrity of femoral head),
4 (loss of acetabular integrity)
Complications of Perthes disease?
Osteoarthritis
Premature fusion of growth plates
Most cases resolve with conservative management.
Early diagnosis improves outcome
Investigations for Perthes disease?
XR: early (widening of joint space), late changes (↓femoral head size/ flat)
Technetium bone scan/ MRI: XR normal, Sx persist
Management of Perthes disease?
Keep femoral head within acetabulum: cast, brace
<6: observation
Older: surgical management
Operate on severe deformities
What is developmental dysplasia of the hip?
disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability.
RF: F>M, breech, pos FH, 1st born child, oligohydramnios, BW >5kg, congen calcaneovalgus foot deformity
More common in left hip
Features of developmental dysplasia of the hip?
Barlow: dislocate an articulated femoral head.
Ortolani: reduce a dislocated femoral head
Restricted abduction of hip flexion
Asymmetry of leg length
Level of knees when hips + knees bilat flexed
Screening for DDH?
Screening: USS if > 1st degree FH of hip problems in early life, breech at/after 36 wks, irrespective of mode of delivery or presentation at birth, multiple preg.
Diagnosis of DDH?
USS: to confirm diagnosis if clinically suspected
Infant >4.5 mnths, XR 1st line investigation
Management of DDH?
Most unstable hips spontaneously stabilise by 3-6 wks of age
Pavlik harness in children <4-5 mnths
Older children may require surgery
What is SUFE?
typically age group is 10-15 years
More common in obese children and boys
Displacement of the femoral head epiphysis postero-inferiorly
May present acutely following trauma or more commonly with chronic, persistent symptoms
Features of SUFE?
hip, groin, medial thigh or knee pain
loss of internal rotation of the leg in flexion
bilateral slip in 20% of cases
Investigations for SUFE?
AP and lateral (typically frog-leg) views are diagnostic
Management of SUFE?
internal fixation: typically a single cannulated screw placed in the center of the epiphysis
What is osteogenesis imperfecta?
more commonly known as brittle bone disease) is a group of disorders of collagen metabolism resulting in bone fragility and fractures.
The most common, and milder, form of osteogenesis imperfecta is type 1
autosomal dominant
abnormality in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides
Features of osteogenesis imperfecta?
presents in childhood
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common - blue/grey or yellow/brown
Basilar skull deformities, can compress CNs
Short stature, scoliosis
Easy bruising
Hypermobility of ligaments, joints, skin
Breathing problems
Complications - Cervical a or aortic dissection
Investigations for osteogenesis imperfecta?
adjusted calcium, phosphate, parathyroid hormone and ALP results are usually normal in osteogenesis imperfecta
Prenatal USS: severe micromelia (small undeveloped extremities).
Postnatal XR: mild thinning of cortical bone, Wormian bones (small irregular bones between cranial sutures)
Biopsy: disorganised bone, ↓of cortical trabecular width, cancellous bone volume, ↑bone remodelling
Dermal fibroblast culture: abnormalities in quality/quantity of collagen synthesis
Management of osteogenesis imperfecta?
Prenatal DNA mutation analysis for at risk pregnancies
Physio to strengthen, ↓ chance to fractures
Bisphosphonates e.g. IV pamidronate
management with intramedullary rod placement, telescoping rods for actively growing individuals
What is scoliosis?
Lat curvature of spine in frontal plane due to rotation of vertebral bodies.
Apparent unequal leg length, F>M. Idiopathic in 85%, either <5 or during puberty
VACTERL
2° to NM imbalance: CP, muscular dystrophy, spina bifida, SMA
2° to disorders of bone/CT: Marfan’s/Ehler’s-Danlos, DDH
Features of scoliosis?
Elevated shoulder on convex side.
Rib humping on bending = asymmetry
Often mild just requiring XR monitoring
Pain + restrictive resp failure if severe
Management of scoliosis?
Monitor
Bracing
Surgical
