Paediatric MSK conditions

Question 1

Common paeds fractures

Answer 1

Growth plate

Supracondylar humeral - must go straight to theatre

Question 2

Special types of fractures in paeds

Answer 2

Buckle

Greenstick

Question 3

Greenstick fractures

Answer 3

Only half a cortex is broken

Question 4

What determines whether surgery is required for a fracture

Answer 4

Stability

Alignment

Question 5

Neuromuscular assessment

Answer 5

Pain 
Pulse 
Pallor 
Paraesthesia 
Paralysis

Question 6

Fracture effects on bone growth

Answer 6

Sometimes grow longer (extensive bone length)

Can also grow shorter

Question 7

Osteogenesis Imperfecta (OI)

Answer 7

Britle bond disorder - congenital
Defeciency of type 1 collagen
Multiple types, ranging in severity
Treat w/ bisphosphonates and lifestyle modifications

Question 8

Infection red flags

Answer 8

ESR 
CRP 
Temp > 38
Inability to weight bear 
Kocher criteria for septic arthritis and osteomyelitis

Question 9

Osteomyelitis in children

Answer 9

More common > 10 yrs
Haemotogenous spread
Affects boys > girls

Question 10

Presentation of osteomyelitis in children

Answer 10

Gradual onset of pain
Unable to weight bear
Fever

Question 11

Predisposing factors for osteomyelitis in children

Answer 11

Diabetes
Immune compromise
Preceding trauma

Question 12

Causes of osteomyelitis

Answer 12

Staph A (MRSA, PVLSA)
Group B strep

Question 13

Management of osteomyelitis

Answer 13

Abx

Rarely surgery

Question 14

Septic arthritis in children

Answer 14

More common < 2 yrs
70% affect hip or knee
Main ddx is Transient synovitis

Question 15

Presentation of septic arthritis in children

Answer 15

Acute onset
Systemic symptoms
Fever
Unwillingness to move joint

Question 16

Predisposing factors for septic arthritis in children

Answer 16

NICU pt

Question 17

Causes of septic arthritis in children

Answer 17

Group B strep
Staph A
N. gonorrhoeae

Question 18

Management of septic arthritis in children

Answer 18

Abx (6 weeks)
Aspiration
incision and drainage

Question 19

Cancers in children - bone pain

Answer 19

1’ malignancy is rare, but common in children
Most commonly osteosarcoma
Haematological cancers can also present as bone pain

Question 20

Primary investigations for cancer in children

Answer 20

CBC

Blood film

Question 21

B symptoms for cancer in children

Answer 21

Anorexia 
Wt loss
Pain that wakes them up at night 
Fatigue 
NIght sweats

Question 22

Developmental dysplasia of the hip

Answer 22

Underdevelopment of the hip joint at birth
in late presentations, there may be a limp
Usually seen in those 0-3

Question 23

Investigating DDH

Answer 23

Xrays and ultrasound

Question 24

Risk factors for DDH

Answer 24

Family hx
Females
Breech
Talipes

Question 25

Newborn screening for DDH

Answer 25

Barlow (dislocation) | Ortolani (relocation)

Question 26

Treatment of DDH

Answer 26

Pavlik harness | Few require open reduction

Question 27

Types of leg length discrepancy

Answer 27

True | Apparent

Question 28

Cause of true leg length discrepancy

Answer 28

Fractures and injuries

Question 29

Cause of apparent leg length discrepancy

Answer 29

Scoliosis

Question 30

Classification of length length discrepancy

Answer 30

More than 2cm difference

Question 31

Causes of leg length discrepancy

Answer 31

DDH Muscle spasticity Growth plate injury

Question 32

Leg length discrepancy in children

Answer 32

Mainly seen in 0-3 yrs Gradual onset/ longstanding symptoms If severe, consider surgical management

Question 33

Juvenile idiopathic arthritis

Answer 33

Affects those 3-10yrs Normally affects multiple joints Gradual onset, persisting May have systemic symptoms

Question 34

Joints affected in juvenile idiopathic arthritis

Answer 34

Knees > wrists > ankle > hip > spine

Question 35

Treatment of JIA

Answer 35

Anti-infl and immunomodulating drugs

Question 36

Perthes' disease

Answer 36

Avascular necrosis of the femoral head leading to collapse Unclear cause Affects boys > girls

Question 37

Risk factors for Perthes' disease

Answer 37

Passive smoking Breech presentation Family hx

Question 38

Conservative treatment for Perthes' disease

Answer 38

Physio - potential for healing Immobilise hip Avoidance of high impact activity

Question 39

Surgical treatment for Perthes' disease

Answer 39

Femoral osteotomy Pelvic osteotomy Hip distraction Salvage procedure (containment)

Question 40

Osteotomy

Answer 40

Removing osteophytes

Question 41

Transient synovitis

Answer 41

Reactive infl of the synonym, 2' to viral infection Acute onset of joint pain/ limp following URTI Self limiting illness Seen in 2-12 yrs, usually boys (70%)

Question 42

Management of transient synovitis

Answer 42

Analgesia - NSAIDs | Resolves spontaneously

Question 43

Slipped upper femoral epiphysis

Answer 43

Mostly seen in fat, pre-pubertal boys (carry most of their weight in their trunk) 25% are bilateral Can be acute or chronic

Question 44

Presentation of SUFE

Answer 44

Groin, hip or knee pain Antalgic gait Difficulty abducting hip/ leg

Question 45

Management of SUFE

Answer 45

Percutaneous pinning

Question 46

Still's disease

Answer 46

Adult - onset juvenile idiopathic arthritis

Question 47

Presentation of Still's disease

Answer 47

A salmon pink macular rash, arthralgia, myalgia, and a spiking high fever

Question 48

Bloods for Still's disease

Answer 48

Elevated ESR, WCC and ferritin | Sero-ve

Question 49

Treatment for Still's

Answer 49

NSAIDs

Question 50

What is crepitus a clinical sign of

Answer 50

Joint damage

Question 51

Clinical signs of joint infl

Answer 51

Stiffness Effusion Increased warmth Soft tissue swelling

Question 52

Ix for transient synovitis

Answer 52

Ultrasound guided hip aspiration