orthopaedics: paediatric lower limb + spine

Question 1

what is developmental dysplasia of the hip (DDH)

Answer 1

dislocation/ subluxation of the femoral head in the perinatal period and then grow out of proportion together

Question 2

what happens to the hip joint as a result of DDH

Answer 2

head of femur and acetabulum misaligned and acetabulum is shallow/ false one forms

Question 3

what are the symptoms of DDH

Answer 3

unilateral limb shortening and groin skin folds, clinks of the hip, OA at a very young age (20s)

Question 4

what test is done at birth to identify DDH

Answer 4

barlow test –> ortolani test

Question 5

what investigations are done after birth to identify DDH

Answer 5

USS then x-ray after 4-6 months

Question 6

how do you treat/ manage DDH

Answer 6

early diagnosis vital, Palvik harness, THR at young age

Question 7

which babies tend to get DDH

Answer 7

first born girls on left hip, FH, breech, down’s

Question 8

what is transient synovitis of the hip

Answer 8

self-limiting inflam of the synovium joint normaly after a URTI

Question 9

who normally gets transient synovitis of the hip

Answer 9

boys aged 2-10

Question 10

what are the symptoms of transient synovitis of the hip

Answer 10

limp, pain weight-bearing, low grade fever

Question 11

what investigations of transient synovitis of the hip

Answer 11

X ray (exclusion), normal CRP, MRI, hip aspiration of concerns

Question 12

what is the treatment of transient synovitis of the hip

Answer 12

NSAIDs and few weeks rest

Question 13

what is Perthes disease

Answer 13

idiopathic osteochondritis (flattened) of femoral head

Question 14

what happens as a result of a flattened femoral head in Perthes disease

Answer 14

AVN, necrosis, fractures, abnormal growth and remodelling

Question 15

who normally gets Perthes disease

Answer 15

boys aged 4-9

Question 16

what are the symptoms of Perthes disease (6)

Answer 16

pain + limp worse on activity, unilateral, atrophy of leg, loss of internal rotation –> loss of abduction, +ive trendellenberg test, V early OA

Question 17

how do you investigate perthes disease

Answer 17

X ray and MRI

Question 18

how do you manage Perthes disease

Answer 18

can resolve spontaneously, avoid activity, braces, THR

Question 19

what is slipped upper femoral epiphysis (SUFE)

Answer 19

femoral head slips down in relation to femoral neck)

Question 20

what causes the femoral head to slip

Answer 20

growth plate (physis) cannot support body weight and slips

Question 21

who gets SUFE

Answer 21

overweight, prepubertal boys, growth spurt can induce

Question 22

what can predispose SUFE

Answer 22

hypothyroidism and renal disease

Question 23

what are symptoms of SUFE

Answer 23

pain + limp, pain in groin, can present in knee (obturator nerve), loss of internal rotation

Question 24

what imaging is needed to diagnose SUFE

Answer 24

X ray of lateral head

Question 25

how do you manage SUFE

Answer 25

surgery to pin femoral head, osteomy, if big slip THR

Question 26

what causes extensor mechanism problems

Answer 26

increased body weight and sporting activity in adolescence

Question 27

what is a common extensor mechanism problem

Answer 27

patellar tendonitis (jumper's knee),

Question 28

how do you manage extensor mechanism problems

Answer 28

normally self-limiting but can require physio

Question 29

how do you manage meniscal tears in children

Answer 29

brace until ages 3/4

Question 30

what is scoliosis

Answer 30

lateral curvature of the spine (sometimes rotational), that is idiopathic, mild and pain free

Question 31

when does scoliosis present and who normally gets it

Answer 31

female adolescence

Question 32

when would an MRI be done for scoliosis

Answer 32

if painful

Question 33

what can scoliosis be secondary to

Answer 33

neuromuscular disease, tumour (osteoid osteoma), skeletal dysplasia, infections

Question 34

what are the risks of large curvature in scoliosis

Answer 34

compression of lungs and heart

Question 35

what are nonsurgical intervention of scoliosis

Answer 35

corrective cast, braces, exercises

Question 36

what are surgical interventions of scoliosis

Answer 36

vertebral fusion

Question 37

what is spondylolisthesis

Answer 37

slippage of one vertebra over another

Question 38

what level does spondylolisthesis normally occur at

Answer 38

L4/L5 or L5,S1

Question 39

what can causes spondylolisthesis

Answer 39

increased weight and activity in adolescence, developmental or recurrent fractures

Question 40

what are symptoms of spondylolisthesis

Answer 40

lower back pain, radiculopathy (pinched nerves), flat back from muscle spasms, waddling gait

Question 41

how do you treat spondylolisthesis

Answer 41

minor: rest + physio. Severe: stabilisation, maybe reduction

Question 42

what is present in adolescent knee pain

Answer 42

softening of hyaline cartilage

Question 43

who normally gets adolescent knee pain

Answer 43

girls

Question 44

how do you treat adolescent knee pain

Answer 44

physio