Orthopaedics Flashcards
What are the various salter harris fracture classifications
SALTR
- Straight across growth plate
- Above growth plate
- Lower than growth plate
- Through growth plate
- cRush
What is the pain management for fractures in children
- Paracetamol or ibuprofen
- Morphine
What are the features of septic arthritis in paeds
Common in under 4s
Staph aureus
Hot red single swollen joint
No weight bearing
Systemic symptoms
Joint aspiration before abx
Empirical IV abx and abx continued for 3-6 weeks
What are the features of transient synovitis in paeds
Most common cause of hip pain between 3-10
Associated with Viral URTI
Limp
No weight bearing
Groin/ hip pain
Mild/ low grade temp
Managament- simple analgesia and safety netting if fever deveops
Symptoms usually resolve in 1-2 weeks
What are the features of Perthe’s disease
Avascular necrosis of femoral head
4-12 yrs old
Usually between 5-8 and boys
Pain in hip/ groin
Limp
Pain referred to knee
Diagnosis by X-ray
Blood tests (usually normal), technetium bone scan, MRI
Management
Maintain healthy alignment
Bed rest, traction, crutches, analgesia, physio
Regular x-rays
Can lead to early hip osteoarthritis due to soft femoral head
What are the features of a slipped upper femoral epiphysis
Head of femur displaced along growth plate
More common in boys 8-15
Earlier in girls 11
OBESE CHILDREN
-Undergoing growth spurt
-Minor trauma - pain disproportionate
Hip will be kept in external rotation- restricted internal rotation on exam
X-ray for diagnosis
Management
Surgery
What are the features of osteomyelitis in paeds
Staph aureus usually
Risk factors
More common in under 10 boys
Open bone fracture
Ortho surgery
Immunocomp
Sickle cell anaemia
HIV / TB
Presentation
Pain, swelling, tender
Low grade fever
X-rays used but can be normal
MRI imaging best
Blood culture needed
Management
Antibiotic therapy
What are the features of osteosarcoma
Bone cancer
Aged 10-20
Most commonly affected the femur
Persistent bone pain worse at night
Urgent direct X-ray within 48 hrs for unexplained bone pain
Destruction of normal bone and fluffy appearance
-Periosteal reaction described as sun-burst appearance
Blood tests show raised ALP
Surgical resection
Adjuvant chemo
What are the features of talipes (clubfoot)
Fixed abnormal ankle position present at birth
talipes equinovarus - ankle in plantar flexion and supination
Talipes calcaneovalgus- dorsiflexion and pronation
Treated with ponseti method- foot put in normal position and held by a cast
Achilles tenotomy to release tendon
What are the features of developmental dysplasia of the hip
Potential for subluxation or dislocation
Risk factors
First degree Fhx
Breech position from 36 weeks
Breech position at birth if 28 weeks onwards
Multiple pregnancy
Findings
Different leg lengths
Restricted hip abduction
Bilat restricted abduction
Clunking hips on barlow and orlani tests
USS of hips is used to help diagnpsis
Plavik harness if less than 6 months old for 6-8 weeks
Surgery if older/ harness doesnt work
What are the features of rickets
-Vitamin D or calcium deficiency
-Defective bone mineralisation
Lethargy, bone pain, swollen wrists, poor growth, bone deformity, muscle weakness
Bowing of legs
Knock knees
Soft skull
Delayed teeth
Less than 25nmol vit D= deficiency
Serum Ca and phopshate will be low
PTH will be high
ALP will be high
Breastfeeding woman- take vit D supplement
Formula is fortified with Vit D
Children- give Vit D 6,000 IU/ day for 8-12 weeks aged 6months -12 yrs
What are the features of Achondroplasia
Autosomal dominant
Abnormal growth plates
Disproportionate short stature (4 feet)
Bow legs, short digits, disproportionate skull
Foramen magnum stenosis (can cause cervical cord compression)
Recurrent otitis media
MDT input
What are the features of Osgood-Schlatters Disease
Inflammation at the tibial tuberosity where the patella ligament inserts
Males aged 10-15 - unilateral usually
Inflammation due to stress from running etc at the same time as the epiphyseal plate is trying to grow
Small avulsion fractures- patella ligament pulls away part of the bone - visible lump below knee - initally tender then hardens and not sore
Gradual symptoms
Palpable hard lump at tibial tuberosity
Anterior knee pain
Pain exacerbated by activity
RICE
What are the features of osteogenesis imperfecta
Brittle bones
Presentation
Hypermobility
Blue/ grey sclera
Triangular face
Short
Deaf in early adulthood
Dental issues
Bone deformities
Joint and bone pain
Bisphosphates and Vit D supplementation
MDT
