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high yield- year 2 > paediatric ortho > Flashcards

paediatric ortho Flashcards

1
Q

what is DDH?

A

-subluxation/ dislocation of hip in the perinatal period

PERINATAL= time you become pregnant up until you give birth

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2
Q

what can occur if DDH is left untreated?

A
  • can cause a very shallow or false acetabulum

- severe arthritis + shortened limb

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3
Q

what hip is DDH more common in?

A

left hip

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4
Q

who is DDH more common in?

A
  • F>M
  • breech position
  • oligohydramnios (low levels amniotic fluid)
  • FH of DDH
  • downsyndrome
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5
Q

investigations for DDH?

A

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)

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6
Q

treatment for dislocates/ unstable DDH?

A

Pavlick harness (6 weeks)

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7
Q

treatment for persistent dislocation> 18 months DDH?

A

-surgical open reduction/ osteotomy

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8
Q

most common cause of hip pain in children?

A

transient synovitis of hip

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9
Q

who more commonly gets transient synovitis of hip?

A
  • recent URTI
  • M>F
  • ages 2 to 10 yrs
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10
Q

investigations for transient synovitis of hip?

A
  • Xray to exclude Perthe’s disease
  • MRI to exclude ostemyelitis of proximal femur
  • CRP= normal (if not normal suspect septic arthritis)
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11
Q

treatment transient synovitis of hip?

A

-NSAIDs + rest

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12
Q

what is Perthes disease?

A

-avascular necrosis of femoral head

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13
Q

who is Perthes more common in?

A

very active boys with small stature

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14
Q

presentation of Perthes?

A
  • progressive unilateral pain/limp
  • loss of internal rotation + loss of abduction
  • positive Trendelenburgs gait (due to gluteal weakness)
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15
Q

what is seen on Xray of Perthe’s?

A

‘hanging rope sign’ + widening of joint space + smaller femoral head with patchy density

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16
Q

treatment of Perthe’s?

A

-regular Xrays

severe= joint replacement

recurrent subluxations (partial dislocations)= osteotomy of femoral head + acetebulum

17
Q

who is SUFE more common in?

A

fat pre pubescent boys

18
Q

how often is SUFE bilateral vs unilateral?

A

1/3rd bilateral

2/3rd unilateral

19
Q

what may be seen on Xray of SUFE?

A

Klein line (needs lateral view)

20
Q

treatment for SUFE?

A

urgent surgery: pin femoral head

if not there is risk of avascular necrosis

21
Q

what is diagnostic criteria for septic arthritis?

A

Kocher criteria

22
Q

treatment for septic arthritis?

A

urgent irrigation + debridement

IV antibiotics cover Gram +ve (flucloaxicillin)

23
Q

presentation of DDH?

A
  • limb shortening
  • asymmetrical groin/thigh skin creases
  • ‘clink/clunk’
24
Q

what nerve may be compressed in SUFE to cause knee pain?

A

obturator nerve (L2-4)

25
Q

how does SUFE present?

A
  • 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
26
Q

what causes duchenne muscular dystrophy?

A

X linked recessive condition

-malformation of the dystrophin gene

27
Q

how does duchennes muscular dystrophy present?

A
  • usually boys aged 1 to 6 who have a waddling gate
  • proximal muscle wasting
  • pseudohypertrophy of calves
  • Gower’s sign positive
28
Q

investigations for duchene muscular dystrophy?

A
  • increased serum creatinine kinase

- Gower’s sign positive

29
Q

prognosis for duchene muscular dystrophy?

A
  • poor prognosis

- usually die in 20s due to cardiac/ resp failure

30
Q

complications of Duchene muscular dystrophy?

A

-dilated cardiomyopathy (30%)

31
Q

difference between Becker’s Muscular dystrophy and Duchennes?

A
  • basically exact same disease
  • Becker’s has slower prognosis
  • Becker’s die in 30-40s
  • Duchenne’s die in 20’s

Duchennes Die first

32
Q

classification for fractures through growth plate?

A

Salter Harris classification

33
Q

Describe type 1 salter harris fracture

A 
I - Straight across
II- A
III- L
IV- T
V- R

Type I- fracture through physis AKA growth plate only (straight across)

34
Q

describe type II salter harris fracture

A 
I - S
II- Above
III- L
IV- T
V- R

Fracture above the physis AKA growth plate and metaphysis

35
Q

describe type III salter harris fracture

A 
I - S
II- A
III- beLow
IV- T
V- R

Fracture below the physis AKA growth plate and epiphysis to include the joint

36
Q

describe type IV salter harris fracture

A 
I - S
II- A
III- L
IV- Through
V- R

Fracture through physis AKA growth plate, epiphysis and metaphysis

37
Q

describe type V salter harris fracture

A 
I - S
II- A
III- L
IV- T
V- cRush

crush injury involving the physis AKA growth plate

high yield- year 2 (20 decks)

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