Orthopaedics/Rheumatology Flashcards
What are the 3 main DD for limping child?
1) Tumour
2) Trauma e.g. NAI, fracture
3) Infection -> sepsis, osteomyelitis
What is the likely cause of a limp in a child aged 0-3?
1) NAI
2) Osteomyelitis/Septic Arthritis
3) DDH
What is the likely cause of a limp in a child aged 3-10?
1) Trauma
2) Transient synovitis
3) Osteomyelitis
4) Perthe’s disease
What is the likely cause of a limp in a child aged 10-15?
1) Trauma
2) Osteomyelitis
3) perthe’s disease
4) SCFE
What are other likely DD in a limping child?
Intra-abdominal illness e.g. T Torsion and hernia
Why should socioeconomic factors be considered in a limp?
Social deprivation and passive smoking are RF’s for Perthe’s disease
What investigations would you do on a child with a limp?
1) General Obs e.g. HR, BP, T, RR, O2 Sats
2) B Tests etc.: FBC, BM, ESR and CRP
3) X-Ray –> AP and lateral views of joint inc above and below
4) USS
5) CT/MRI
What is Kocher’s criteria
Criteria for needing 3/4 for septic joint:
1) Can’t weight bear
2) T>38.5
3) CRP >20
ESR>40
4) WCC >12
What are 3 signs of septic arthritis
Systemically very unwell, pain at rest, ^ WCC/CRP
Define transient synovitis
Acute onset joint inflammation after illness (Usually respiratory)
How does transient synovitis differ from SA?
1) No pain at rest
2) XR normal
3) USS show effusion
4) Rest
5) Physiotherapy
6) NSAIDs
Define DDH
Developmental dysplasia of hip
- Abnormal relationship of femoral head to acetabulum
(Aberrant development of the hip)
What are the RF and what tests can be done in clinical examination for DDH?
RF: Female (1:8 comp male), First born, Breech birth, Family history
Tests: Ortolani test, Barlow Manoeveure (Confirmed with USS)
What 3 lines can be drawn to aid DDH diagnosis
1) Hilgenreiner line
2) Perkin line (Perpendicular to Hilgenreiner)
3) Shenton
What is the management of DDH?
1) Pavlik harness
2) Surgical reduction (X –> avascular necrosis, re-dislocation)
Define Perthe’s disease
Self limiting disease characterised by avascular necrosis of femoral head
What is the management of PD?
Contain hip –> On own or with aid: plasters, brace, Physio, surgery
What are RF of PD?
1) ADHD 2) Deprivation 3) LBW 4) Passive smoking 5) Short stature
What is SCFE?
Slipped capital femoral epiphysis –> Fracture through G Plate leading to slippage of femoral head through zone of hypertrophy
Who and how will SCFE present to?
Pre-pubescent obese male
How: Complain of several week Hx of vague groin/thigh discomfort –> Waddling gait and decreased range of motion (Bilateral in 40%)
What is treatment for SCFE?
Surgical pinning of the hip
What criteria is needed for making a clinical diagnosis of JIA?
Joint swelling/stiffness >6 weeks in children <16 and no other cause identified
What symptoms are associated with JIA?
1) Fever 2) Salmon-pink rash 3) Uveitis 4) Pain 5) Morning stiffness 6) Swelling
What non-medical treatment is used for JIA?
Information, Education, Support, Liason with school, Physiotherapy
What are the main consequences for failing to treat JIA?
1) Damage 2) Deformity 3) Disability 4) Pain 5) bony overgrowth 6) uveitis
What is the medical treatment for JIA?
1) Steroid injections
2) NSAIDs
3) Methotrexate
4) Systemic steroids
Name an organism that commonly causes osteomyelitis in children.
Staphylococcus aureus.
What are the main S/S of OM in children?
1) Lethargy
2) Fever
3) Joint pain
What investigations would do on child with suspected infected joint?
XR.
MRI.
Blood cultures.
Joint aspirate.
What is the main treatment plan for OM in children?
IV cefuroxime or IV flucloxacillin.
6 weeks of treatment, can switch to PO when improving.
