Orthopaedics Flashcards
most common cause of hip pain in children
transient synovitis
- temporary inflammation of the synovial membrane
what precedes transient synovitis
URTI
presentation of transient synovitis
hip pain/limp/refusal to weight bear in context of viral illness
child otherwise well – no fever, this would suggest septic arthritis
management is symptomatic
what is septic arthritis?
what is the most common cause?
infection inside a joint
most commonly caused by staph. aureus
presentation of septic arthritis
acute onset red, swollen, hot, painful joint
limited range of movement
fever
ix of septic arthritis
joint aspiration
- ABX given once causative organism confirmed
what is Perthes disease
avascular necrosis of femoral head
who typically gets Perthes disease
boys age 5-8 years
presentation of Perthes
slow onset pain in hip/groin
may have referred pain to knee
restricted movements
ix of Perthes
XRAY
management of Perthes
bed rest + limit physical activity
analgesia
regular XRAYS
what is a SUFE
slipped upper femoral epiphysis
- head of femur ‘slips’ along the growth plate
who typically gets a SUFE
obese boys 10-15 years old
main clinical sign in SUFE
loss of internal rotation
Ix of SUFE
Xray
management of SUFE
pin in the femoral head
what is osteomyelitis
infection in the bone + bone marrow
- typically in the metaphysis of long bones
- staph. aureus most common cause
presentation of osteomyelitis
often a risk factor that predisposes the child - open fracture / orthopaedic surgery / immunocompromised
subacute pain, swelling, tenderness
Ix of osteomyelitis
MRI
blood culture
what is DDH
developmental dysplasia of the hip
- abnormal development of bones during pregnancy leading to hip instability with tendency to sublux / dislocate
signs of DDH
different leg lengths
extra thigh skin fold
+ Barlows / Ortolanis test
what are Barlows + Ortolani tests
Barlows - attempts to dislocate femoral head
Ortolanis - attempts to relocate a dislocated femoral head
which infants require USS screening for DDH at 6 weeks?
breech > 36 weeks
multiple pregnancy
+ ve frist degree relative with hip problems
management of DDH infant < 6 months
Pavlik harness
- keeps hips flexed + abducted
what is Talipes equinovarus
Clubfoot
- fixed abnormal ankle position: plantar flexion + supination
tx of talipes equinovarus
Ponseti method
- casts used to hold foot in normal position
what causes Rickets
vitamin D or calcium deficiency
called osteomalacia in adults
what is Osgood Slatters disease
osteochondritis caused by inflammation at the tibial tuberosity
presentation of Osgood Slatters disease
palpable tender lump at tibial tuberosity
anterior knee pain exacerbated by physical activity, kneeling or knee extension
management of Osgood Slatters disease
reduction in physical activity
NSAIDs
Ice
what is osteogenesis imperfecta
genetic condition that results in brittle bones that are prone to fractures
presentation of osteogenesis imperfecta
recurrent fractures
blue / grey sclera of the eyes
short stature
early onset deafness
management of osteogenesis imperfecta
cannot be cured, can only manage symptoms + prevent fractures
- biphosphonates
- Vit D supplements
- physio + occupational therapy
knee pain post exercise with intermittent swelling / locking
osteochondritis dessicans
how should a child < 3 years old with a limp be managed
urgent hospital assessment
investigation of DDH after 4.5 months old
XRAY
