paediatric ortho Flashcards
what is DDH?
-subluxation/ dislocation of hip in the perinatal period
PERINATAL= time you become pregnant up until you give birth
what can occur if DDH is left untreated?
- can cause a very shallow or false acetabulum
- severe arthritis + shortened limb
what hip is DDH more common in?
left hip
who is DDH more common in?
- F>M
- breech position
- oligohydramnios (low levels amniotic fluid)
- FH of DDH
- downsyndrome
investigations for DDH?
Barlow’s or Ortolani test
Barlow’s= Bad= try to dislocate an articulated femoral head by adducting the hip and applying a posterior force
Ortolani= try to relocate a dislocated femoral head by abducting the hip and applying an anterior force
-if either are positive USS (cannot Xray until after 4-6 months)
treatment for dislocates/ unstable DDH?
Pavlick harness (6 weeks)
treatment for persistent dislocation> 18 months DDH?
-surgical open reduction/ osteotomy
most common cause of hip pain in children?
transient synovitis of hip
who more commonly gets transient synovitis of hip?
- recent URTI
- M>F
- ages 2 to 10 yrs
investigations for transient synovitis of hip?
- Xray to exclude Perthe’s disease
- MRI to exclude ostemyelitis of proximal femur
- CRP= normal (if not normal suspect septic arthritis)
treatment transient synovitis of hip?
-NSAIDs + rest
what is Perthes disease?
-avascular necrosis of femoral head
who is Perthes more common in?
very active boys with small stature
presentation of Perthes?
- progressive unilateral pain/limp
- loss of internal rotation + loss of abduction
- positive Trendelenburgs gait (due to gluteal weakness)
what is seen on Xray of Perthe’s?
‘hanging rope sign’ + widening of joint space + smaller femoral head with patchy density
treatment of Perthe’s?
-regular Xrays
severe= joint replacement
recurrent subluxations (partial dislocations)= osteotomy of femoral head + acetebulum
who is SUFE more common in?
fat pre pubescent boys
how often is SUFE bilateral vs unilateral?
1/3rd bilateral
2/3rd unilateral
what may be seen on Xray of SUFE?
Klein line (needs lateral view)
treatment for SUFE?
urgent surgery: pin femoral head
if not there is risk of avascular necrosis
what is diagnostic criteria for septic arthritis?
Kocher criteria
treatment for septic arthritis?
urgent irrigation + debridement
IV antibiotics cover Gram +ve (flucloaxicillin)
presentation of DDH?
- limb shortening
- asymmetrical groin/thigh skin creases
- ‘clink/clunk’
what nerve may be compressed in SUFE to cause knee pain?
obturator nerve (L2-4)
how does SUFE present?
- Hip pain (patient prefers hip externally rotated and has limited internal rotation)
- Knee pain (due to compression of obturator nerve)
- limp
- leg may appear shorter
what causes duchenne muscular dystrophy?
X linked recessive condition
-malformation of the dystrophin gene
how does duchennes muscular dystrophy present?
- usually boys aged 1 to 6 who have a waddling gate
- proximal muscle wasting
- pseudohypertrophy of calves
- Gower’s sign positive
investigations for duchene muscular dystrophy?
- increased serum creatinine kinase
- Gower’s sign positive
prognosis for duchene muscular dystrophy?
- poor prognosis
- usually die in 20s due to cardiac/ resp failure
complications of Duchene muscular dystrophy?
-dilated cardiomyopathy (30%)
difference between Becker’s Muscular dystrophy and Duchennes?
- basically exact same disease
- Becker’s has slower prognosis
- Becker’s die in 30-40s
- Duchenne’s die in 20’s
Duchennes Die first
classification for fractures through growth plate?
Salter Harris classification
Describe type 1 salter harris fracture
I - Straight across II- A III- L IV- T V- R
Type I- fracture through physis AKA growth plate only (straight across)
describe type II salter harris fracture
I - S II- Above III- L IV- T V- R
Fracture above the physis AKA growth plate and metaphysis
describe type III salter harris fracture
I - S II- A III- beLow IV- T V- R
Fracture below the physis AKA growth plate and epiphysis to include the joint
describe type IV salter harris fracture
I - S II- A III- L IV- Through V- R
Fracture through physis AKA growth plate, epiphysis and metaphysis
describe type V salter harris fracture
I - S II- A III- L IV- T V- cRush
crush injury involving the physis AKA growth plate
