orthopaedics: paediatric lower limb + spine Flashcards
what is developmental dysplasia of the hip (DDH)
dislocation/ subluxation of the femoral head in the perinatal period and then grow out of proportion together
what happens to the hip joint as a result of DDH
head of femur and acetabulum misaligned and acetabulum is shallow/ false one forms
what are the symptoms of DDH
unilateral limb shortening and groin skin folds, clinks of the hip, OA at a very young age (20s)
what test is done at birth to identify DDH
barlow test –> ortolani test
what investigations are done after birth to identify DDH
USS then x-ray after 4-6 months
how do you treat/ manage DDH
early diagnosis vital, Palvik harness, THR at young age
which babies tend to get DDH
first born girls on left hip, FH, breech, down’s
what is transient synovitis of the hip
self-limiting inflam of the synovium joint normaly after a URTI
who normally gets transient synovitis of the hip
boys aged 2-10
what are the symptoms of transient synovitis of the hip
limp, pain weight-bearing, low grade fever
what investigations of transient synovitis of the hip
X ray (exclusion), normal CRP, MRI, hip aspiration of concerns
what is the treatment of transient synovitis of the hip
NSAIDs and few weeks rest
what is Perthes disease
idiopathic osteochondritis (flattened) of femoral head
what happens as a result of a flattened femoral head in Perthes disease
AVN, necrosis, fractures, abnormal growth and remodelling
who normally gets Perthes disease
boys aged 4-9
what are the symptoms of Perthes disease (6)
pain + limp worse on activity, unilateral, atrophy of leg, loss of internal rotation –> loss of abduction, +ive trendellenberg test, V early OA
how do you investigate perthes disease
X ray and MRI
how do you manage Perthes disease
can resolve spontaneously, avoid activity, braces, THR
what is slipped upper femoral epiphysis (SUFE)
femoral head slips down in relation to femoral neck)
what causes the femoral head to slip
growth plate (physis) cannot support body weight and slips
who gets SUFE
overweight, prepubertal boys, growth spurt can induce
what can predispose SUFE
hypothyroidism and renal disease
what are symptoms of SUFE
pain + limp, pain in groin, can present in knee (obturator nerve), loss of internal rotation
what imaging is needed to diagnose SUFE
X ray of lateral head
how do you manage SUFE
surgery to pin femoral head, osteomy, if big slip THR
what causes extensor mechanism problems
increased body weight and sporting activity in adolescence
what is a common extensor mechanism problem
patellar tendonitis (jumper’s knee),
how do you manage extensor mechanism problems
normally self-limiting but can require physio
how do you manage meniscal tears in children
brace until ages 3/4
what is scoliosis
lateral curvature of the spine (sometimes rotational), that is idiopathic, mild and pain free
when does scoliosis present and who normally gets it
female adolescence
when would an MRI be done for scoliosis
if painful
what can scoliosis be secondary to
neuromuscular disease, tumour (osteoid osteoma), skeletal dysplasia, infections
what are the risks of large curvature in scoliosis
compression of lungs and heart
what are nonsurgical intervention of scoliosis
corrective cast, braces, exercises
what are surgical interventions of scoliosis
vertebral fusion
what is spondylolisthesis
slippage of one vertebra over another
what level does spondylolisthesis normally occur at
L4/L5 or L5,S1
what can causes spondylolisthesis
increased weight and activity in adolescence, developmental or recurrent fractures
what are symptoms of spondylolisthesis
lower back pain, radiculopathy (pinched nerves), flat back from muscle spasms, waddling gait
how do you treat spondylolisthesis
minor: rest + physio.
Severe: stabilisation, maybe reduction
what is present in adolescent knee pain
softening of hyaline cartilage
who normally gets adolescent knee pain
girls
how do you treat adolescent knee pain
physio
