Paediatric MSK Flashcards
What are your differentials for a child with an acute limp?
Need to exclude: Septic arthritis Osteomyelitis SUFE Perthes DDH Fracture/trauma Malignancy
Other:
Transient synovitis of hip
Functional limp
JIA/reactive arthritis
a child presents with a limp. what are some key questions you need to ask?
Acute or chronic/insidious onset?
Able to weightbear/walk at all?
Any previous trauma?
Any recent illnesses? (particularly gastro etc)
Any other illnesses such as IBD etc?
Do they have a fever or any other infective symptoms?
Any deformity/swelling noticed?
Pain with certain movements?
Morning stiffness or history of ‘gelling’ after long car rides?
Birth history–> risk factors for DDH
Systemic constitutional symptoms of malignancy?
FMH of rheumatoid arthritis/SLE/autoimmunity
what are some key investigations all children with suspected bone/joint infections get?
blood culture FBE blood film plain x-rays CRP
then +/- joint aspirate; bone scan/MRI according to clinical judgement
what are the three clinical presentations of JIA?
oligoarticular JIA
polyarticular JIA
systemic JIA (still’s disease)
what are some complications of untreated JIA?
overgrowth of limb and subsequent deformity
erosive disease
what is the most common cause of intoeing in children?
internal femoral torsion
what does talipes equinovarus mean?
clubfoot deformity- can either be postural or fixed
what is osgood schlatter’s syndrome
this is when there is pain and swelling of the tibial tuberosity due to inflammation of the patellar ligament.
often clinically seen as a tender bump/lump on the tibial tuberosity in active 10-14 yr olds.
self resolving over many months with physiotherapy to strengthen quadriceps/hamstring muscles.
some may require surgical excision of lump
what is a good way of seeing whether there is any hip involvement in a child who presents with joint pain?
as the child to ‘squat and walk like a duck’. if they are able to do so; then unlikely to involve the hip
what must you exclude in a child you suspect might have systemic JIA?
septic arthritis
malignancy
osteomyelitis
where often does SUFE pain present?
can present as thigh/knee pain, hence always assess the hip joint
what is the treatment of SUFE?
surgical correction with screws
a child presents with dactylitis. what condition must you think of?
psoriatic arthritis
what is the technical name for ‘banana shaped feet’?
metatarsus adductus
up to which age is bowed legs considered normal?
up to 2 yrs; it is common for toddlers to appear bowed legged
what is a ddx for osgood schlatter disease?
enthesitis, particularly if both knees are affected
a child complains of leg pain at night. what are your differentials?
growing pains (especially if bilateral)- most common
benign osteoma (if unilateral)- rare
what are the common malignant causes of bone pain in children?
leukaemia
neuroblastoma
lymphoma
what are the two most common primary bony malignancies in children?
osteosarcoma
ewings sarcoma
what is the difference between osteomalacia and rickets?
no difference; both mean a disorder in bone mineralisation often due to vitamin D deficiency or calcium deficiency.
rickets is the condition in kids and osteomalacia is the condition in adults
what are some causes of rickets in a child?
vitamin D deficiency due to little vitamin D exposure, malabsorption disorders, severe liver disease, prolonged anticonvulsant therapy
a child comes in with a confirmed elbow fracture. how might you manage their pain in ED?
Pharmacological
- Simple analgesia= panadol up to 20mg/kg
- Intranasal fentanyl
- IV morphine if required
- ketamine if manipulating fracture
Non-pharmacological
- distraction techniques, play therapy
- immobilisation, bracing
a young child falls on her outstretched hand. What type of fractures is she at risk of?
- buckle fracture of the distal radius
- greenstick fracture of the distal radius
- complete fracture of the distal radius
- supracondylar fracture of the elbow
- scaphoid fracture
- proximal humeral fracture
- lateral condylar fracture
what is a quick way of assessing neurological involvement in child with an upper limb fracture?
Ask them to:
Make a fist- median nerve
Make a star with their hands- testing ulnar nerve
Give you the thumbs up- radial nerve
how do we classify supracondylar fractures and which is more common?
flexion - distal fragment displaced anteriorly
extension- more common; distal fragment displaced posteriorly
what are the complications of a supracondylar fracture?
Deformity due to malunion
Neuropraxia
Vascular compromise- radial or brachial artery
–>compartment syndrome
what is the peak age group for a supracondylar fracture in children?
5-8 yrs old
a child presents with a fracture of the shaft of the humerus. what must you consider?
non-accidental injury
a boy presents with a sore elbow after falling on an outstretched hand. on examination the elbow has reduced ROM, is tender and there is swelling, more markedly on the lateral side. what are you worried about and how could you confirm this?
ix= AP and lateral x-rays of elbow
looking for lateral condylar fracture
–> always requires an urgent orthopaedic review due to known poor outcomes
