Paediatric Musculoskeletal, Neurological - DDH, Talipes equinovarus, Transient synovitis, Cerebral palsy, Achondroplasia, Febrile convulsions

Question 1

Developmental dysplasia of the hip
-what is it?
-risk factors
-screening and examination
-management

Answer 1

Ball and socket joint does not form properly

Female
Breech at 36wk+
FHx
1stborn
Oligohydramnios/macrosomic - not enough space for joints to form

Barlow - dislocate articulated femoral head
Ortolani - relocate dislocated femoral head
Symmetry of leg length
Level of knees when knees and hips flexed
Restricted abduction of hip in flexion
CONFIRMED WITH US in 6wks
-if 4.5months+ => XRAY

Spontaneous stabilisation by 3-6wks
Dynamic flexion-abduction orthosis if U4-5months
Older children - surgery

Question 2

Talipes equinovarus
-what is it
-screening

Answer 2

Inverted, plantarflexed foot

If it is not passively correctable => clinical diagnosis

Identified on NIPE

Manipulation and progressive casting after 6wks

Question 3

Transient synovitis
-what is it
-presentation
-investigations
-management

Answer 3

MOST COMMON CAUSE OF HIP PAIN IN CHILDREN
Acute hip pain after recent viral infection
Age - 3-8

Limp/refusal to weight bear
Groin/hip pain
Low grade fever
-high grade fever increases suspicion of septic arthritis

Fever => urgent special assessment to rule out septic arthritis
Clinical diagnosis if well, no fever but limping, symptoms U72hrs

Self limiting, rest and analgesia

Question 4

Achondroplasia
-what is it
-risk factor
-presentation
-investigations
-managements

Answer 4

AD => abnormal cartilage

Increasing paternal age

SHORT STATURE
-short limbs, fingers
-large head, frontal bossing
-narrow foramen magnum
-midface hypoplasia, flat nasal bridge
-trident hands
-lumbar lordosis

Detected on prenatal US
Postnatally - diagnosed on physical and radiographic features

No specific therapy
-limb lengthening procedures

Question 5

Febrile convulsions
-age group
-presentation
-types

Answer 5

Provoked by sudden increase in fever
-6months - 5 years
-regular anytipretics do not reduce chance of febrile seizure

Early in viral infection
Brief, last U5mins
Mostly tonic clonic

Simple
-U15mins
-generalised
-no recurrence within 24hrs
-complete recovery in 1hr

Complex
-15-30mins
-focal seizure
-may have repeat seizure in 24hrs

Febrile status epilepticus
-30mins+

1st seizure or complex => admit to paediatrics
5mins+ => LAS
Multiple febrile seizures => rectal diazepam/buccal midazolam (specialist)

Question 6

Normal lower limb variants and management
-pes planus
-in toeing
-out toeing

Answer 6

Pes planus - arises at all ages
-no medial arch on standing
-orthotics not recommended
-parental reassurance => resolves by 4-8

In toeing - arises at 1
-generally resolves but if severe may need serial casting

Out toeing - arises at all ages
-resolves by 2

Bow legs - arises at 1-2
-increased intercondular distance
-resolves by 4-5

Knock knees - arises at 3-4
-increased intermalleolar distance
-resolves spontaneously

Question 7

Growing pains
-what are they
-presentation
-management

Answer 7

Leg pain with no obvious cause or other symptoms or signs
-equally common in boys and girls, 3-12

Night pain
-bilateral
-self limiting
-worse after day of vigorous activity
No limp, limitation of physical activity

Normal physical examination
Normal milestone development

Reassurance