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Paediatrics > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

How are bones in children different to adults?

A
  • have growth plates
  • more cancellous (spongy and highly vascular)
  • more flexible but less strong - hence more prone to greenstick fractures
  • heal more quickly with less long term deformity
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2
Q

What type of fractures are more likely in children?

A
  • greenstick
  • buckle (torus)
  • salter harris (growth plate)
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3
Q

What is a greenstick fracture?

A

Where only one side of the bone breaks.

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4
Q

Name some different types of fractures?

A
  • transverse
  • oblique
  • spiral
  • segmental
  • salter harris (growth plate)
  • comminuted
  • greenstick
  • buckle (torus)
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5
Q

Describe the SALTR mnemonic for growth plate fractures

A
  • Type 1 - Straight across
  • Type 2 - Above
  • Type 3 - beLow
  • Type 4 - Through
  • Type 5 - cRush
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6
Q

How should fractures be managed?

A
  • achieve alignment then stability
  • closed reduction (manipulation) - stabilise with external cast
  • open reduction with surgery and fixation (e.g screws, nails)

Pain management - paracetamol or iBuprofen. Morphine if severe.

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7
Q

What is septic arthritis?

A

infection inside the joint

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8
Q

In which children is septic arthritis most common?

A

Under 4s
Or after operations - particularly joint replacements

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9
Q

How does septic arthritis present?

A
  • hot, swollen, erythematous painful joint
  • refusing to weight bear
  • stiffness and reduced range of motion
  • systemic features - fever, signs of sepsis
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10
Q

What bacteria commonly cause septic arthritis?

A

Staph aureus

Others include
- neisseria gonorrhoea in sexually active teens
- Group A strep (pyogenes)
- haem influenza
- E.coli

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11
Q

What are some differentials for septic arthritis?

A
  • transient synovitis
  • perthes disease
  • slipper upper femoral epiphysis
  • juvenile idiopathic arthritis
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12
Q

How is septic arthritis managed?

A
  • have low threshold for investigating and treating as it can be subtle in young children.
  • admit to hospital and involve ortho
  • aspirate, microscopy and culture and sensitivities for diagnosis
  • Empirical IV abx then specialise - for 3-6 wks
  • may require surgical drainage and washout if severe
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13
Q

What is rickets?

A

Condition where there is defective bone mineralisation causing soft and deformed bones due to a deficiency in vitamin D or calcium.

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14
Q

How do we get vitamin D?

A
  • produced in the body in response to sunlight
  • through food - e.g. eggs, oily fish or fortified cereals
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15
Q

In which foods is calcium found?

A
  • dairy - milk, cheese etc.
  • some green veg
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16
Q

What is the equivalent to rickets in adults?

A

Osteomalacia

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17
Q

Who is more likely to have vitamin D insufficiency?

A
  • darker skin
  • avoiding sunlight
  • malabsorption disorders - e.g. IBD
  • chronic kidney disease ( as metabolises the vitamin D into its active form)
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18
Q

Why does a lack of Vitamin D affect bones?

A
  • Vit D is essential for absorption of calcium and phosphate, which are required for the construction of bone.
  • Low calcium then causes a secondary hyperparathyroidism.
  • Hence more parathyroid hormone is produced. This stimulates reabsorption of calcium from the bones, worsening bone mineralisation.
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19
Q

What are some of the bone deformities seen in rickets?

A
  • bowing of the legs (curve outwards)
  • knock knees (legs curve inwards)
  • rachitic rosary - ribs expand at the costochondral junctions
  • delayed teeth
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20
Q

What are potential symptoms of rickets?

A
  • lethargy
  • bone pain
  • swollen wrists
  • bone deformity
  • poor growth
  • dental problems
  • muscle weakness
  • pathological or abnormal fractures
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21
Q

What investigations are done for rickets?

A
  • blood test of vitamin D levels (<25nmol/L is deficiency)
  • XRAY - may show osteopenia = more radiolucent bones
  • serum calcium, phosphate, ALP or parathyroid hormone levels
  • also do routine bloods to look for other pathologies / underlying causes
22
Q

How is rickets managed?

A
  • Breastfeeding women and children - take vitamin D supplements
  • Treat with Vitamin D and calcium supplementation.
  • Dose depends on age. Approx 6000IU per day.
23
Q

What is osteosarcoma?

A

A type of bone cancer that most commonly affects young people between 10 and 20 years old.

24
Q

In what bones is osteosarcoma most likely to occur?

A
  • femur
  • tibia
  • humerus
25
Q

How does osteosarcoma present?

A
  • persistent bone pain - particularly worse at night

May have
- bone swelling
- a palpable mass
- restricted bone movements

26
Q

How is osteosarcoma diagnosed?

A
  • urgent direct access XRAY
  • blood tests (show raised ALP)

To stage can do
- MRI
- CT
- Bone scan
- PET scan
- bone biopsy

27
Q

What does osteosarcoma look for on XRAY?

A
  • poorly defined region in bone
  • destruction of normal bone and a ‘fluffy’ appearance
  • may be associated soft tissue mass
28
Q

How is osteosarcoma managed?

A
  • surgical resection - often with limb amputation
  • adjuvant chemotherapy

Close follow up with a MDT team.

29
Q

What are the main complications of osteosarcoma?

A
  • pathological bone fractures
  • metastises
30
Q

What is achondroplasia?

A
  • The most common cause of disproportionate short stature - dwarfism.
  • Skeletal dysplasia due to a mutation on the fibroblast growth factor receptor 3 gene (FGFR3) on chromosome 4.
  • it can be sporadic mutation or is autosomal dominant (one abnormal and one normal chromosome - as homozygous is fatal in neonatal period)
31
Q

How does the genetic mutation in the FGFR3 gene affect bone growth?

A
  • abnormal function of epiphyseal plates, restricting bone growth in length. Also other dysplasia effects.
32
Q

What is the average height of someone with achondroplasia?

A

4 feet

33
Q

Describe the features of achondroplasia?

A
  • short stature
  • short limbs (particularly proximal - humerus and femur)
  • normal trunk length
  • short digits
  • bow legs - genu varum
  • disproportionate skull - large head
  • flattened mid face and nasal bridge
  • foramen magnum stenosis
34
Q

What conditions is achondroplasia associated with?

A
  • recurrent otitis media - due to cranial abnormalities
  • kyphoscoliosis
  • spinal stenosis
  • obstructive sleep apnoea
  • obesity (relative to height)
  • foramen magnum stenosis can lead to cervical cord compression, hydrocephalus and can be fatal
35
Q

How is achondroplasia managed?

A
  • MDT support - to maximise functioning - e.g. physio, occupational therapists, ortho
  • no cure
36
Q

What is the life expectancy with achondroplasia?

A

Normal (if not affected by complications)

37
Q

What is osteogenesis imperfecta?

A
  • genetic condition - brittle bone disease
  • prone to fractures
  • range of genetic mutations that affect the formation of collagen (8 types that vary is severity)
38
Q

How does osteogenesis imperfecta present?

A
  • recurrent, inappropriate fractures
  • hypermobility
  • grey/blue sclera of the eyes
  • triangular face/jaw
  • short stature
  • deafness from early adulthood
  • dental problems - formation of teeth
  • bone deformities - bowed legs and scoliosis
  • joint and bone pain
39
Q

How is osteogenesis imperfecta diagnosed?

A
  • clinical diagnosis
  • XRAYs can be useful for fractures and bone deformities
    -genetic testing is possible but not done routinely
40
Q

How is osteogenesis imperfecta managed?

A
  • give bisphosphates and vit D supplements to help increase bone density
  • managed by MDT
  • physiotherapy
  • occupational therapy
  • ortho
    etc.
41
Q

What is osteomyelitis?

A

Infection in the bone or bone marrow. Can be acute or chronic.

42
Q

What organism most commonly causes osteomyelitis?

A

Staphylococcus aureus (gram+)

43
Q

How does someone get osteomyelitis?

A

Bacteria can enter directly - e.g. from an open fracture. Or have travelled via the blood after entering via another route - e.g. skin or gums

44
Q

What are some risk factors for osteomyelitis?

A
  • children <10
  • open bone fracture
  • orthopaedic surgery
  • immunocompromised
  • sickle cell anaemia
  • HIV
  • TB
45
Q

How does osteomyelitis present?

A

Acute or chronic
- refusing to weight bear or use the limb
- pain
- swelling
- tenderness
- fever (chronic = low grade, acute = high)
- look out for signs it has spread to the joint causing septic arthritis

46
Q

How is osteomyelitis investigated?

A
  • Imaging - Xrays , MRI (best) or bone scan
  • bloods = raised CRP and ESR and WCC
  • blood culture
  • bone marrow aspirate or bone biopsy with histology may be needed
47
Q

How is osteomyelitis managed?

A
  • prolonged antibiotic therapy
  • may need surgical drainage and debridement of infected bone
48
Q

What is another name for talipes?

A

club foot

49
Q

What is talipes / club foot?

A

Where there is a fixed, abnormal ankle position at birth

50
Q

What is talipes equinovarus?

A

When the ankle is in plantar flexion and supination

51
Q

What is talipes calcaneovalgus?

A

When the ankle is in dorsiflexion and pronation

52
Q

How is club foot treated?

A
  • ‘ponseti method’ - foot is manipulated towards a normal position and a cast is applied to hold it in position immediately after birth. This is repeated multiple times until the foot is in the right position. Often also need a achilles tenotomy to relieve tension. Then use a brace to keep in place until the child is walking / approx 4 years old.
  • surgery may be required if this fails

Paediatrics (14 decks)

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