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Year 3 - Musculoskeletal > Paediatric Ortho - The big three > Flashcards

Paediatric Ortho - The big three Flashcards

1
Q

Causes of hip problems in 0-5 yrs?

A 
> ‘Normal variant’
> Trauma
> Transient synovitis 
> Osteomyelitis 
> Septic arthritis 
> DDH
> JIA
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2
Q

Causes of hip problems in 5-10 yrs?

A 
> Trauma
> Transient synovitis
> Osteomyelitis 
> Septic arthritis 
> Legg-Calve (Perthes disease)
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3
Q

Causes of hip problems in 10-15 yrs?

A 
> Trauma
> Osteomyelitis 
> Septic arthritis 
> SUFE
> Chrondromalacia 
> Neoplasm
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4
Q

Countries (Aetiology) of developmental dysplasia of the hip?

A

> Northern Europe 0.7 to 2.2 per 1000

> Eastern Europe = 28.7/1000

> African Neonates = 0

> Apaches and Navajos = 5%

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5
Q

Are girls or boys more likely to have developmental dysplasia of the hip?

A

Girls 6:1

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6
Q

Which hip is more commonly have developmental dysplasia of the hip?

A

The left hip, 3:1

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7
Q

Aetiology of developmental hip dysplasia?

A 
> Girls
> First born
> Oligohydramnios 
> Breech delivery 
> Family history 
> Other limb deformities 
> Baby >10lbs
> Apaches and Navajos = 5%
> Eastern Europe  = 28.7/100
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8
Q

Clinical features of developmental hip dysplasia?

A

> Ortolani’s Sign
Barlow’s Sign
Piston Motion Sign
The Hamstring Sign

However only 40% DDH are picked up by examination

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9
Q

Management of developmental hip dysplasia - <3 months?

A

Simple splint = 90% response

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10
Q

How does someone usually present with Legg-Calve-Perthes Disease?

A 
> Male 5:1
> Primary school age 
> Short stature 
> Limp 
> Knee pain on exercise 
> Stiff hip joint 
> Family tendency 
> Low social status
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11
Q

Phases of Legg-Calve Perthes Disease?

A

> Avascular necrosis

> Fragmentation - Revascularisation (Painful)

> Reossification - Bony healing

> Residual deformity

Takes around 3 years and can be left with a deformed hip

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12
Q

Treatment of Legg-Calve-Perthes Disease?

A

> Analgesia

> Restrict painful activities

> ‘Supervised neglect’ in most cases

> ‘Containment’ - Consider osteotomy in selected groups of older children (>7)

> Prognosis good onset <9y

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13
Q

Treatment of Legg-Calve-Perthes Disease?

A

> Analgesia

> Restrict painful activities

> ‘Supervised neglect’ in most cases

> ‘Containment’ - Consider osteotomy in selected groups of older children (>7)

> Prognosis good onset <9y

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14
Q

Aetiology of slipped upper (capital) femoral epiphysis (SCFE)?

US call is Slipper capital femoral epiphysis (SCFE)

A 
> 1-10 per 100,000
> Teenage boys > Girls (9-14 yrs)
> 20% become bilateral 
> Many overweight 
> Small proportion endocrine abnormalities (If they are short thick about it)
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15
Q

Classification of SUFE?

A

> Acute Vs Chronic (3 weeks)

> Stable yrs unstable (Lober)

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16
Q

What time scale to indicate chronic SUFE?

A

> 3 weeks

17
Q

How is unstable SUFE managed?

A

> Fix - serendipitous reduction

> Unable to weight-bear, poor prognosis (Higher risk of developing avascular necrosis)

18
Q

How is stable SUFE managed?

A

> Fix in situ

> Able to weight-bear, good prognosis

19
Q

Detection of SUFE?

A

> Pain in hip or knee
Externally rotated posture and gait
Reduced internal rotation, especially in flexion
Plain X-rays (Best seen on lateral view)

20
Q

Detection of SUFE - Radiographic features?

A

> Mild <1/3
Moderate 1/3-1/2
Severe >1/2

21
Q

Pathology of SUFE?

A

> Displacement through hypertrophic zone (Growth plate)

> Metaphysis moves anterior and proximal

22
Q

SUFE - Treatment?

A

Surgical:
> Stable slips are pinned in situ (Through the femoral head)
> Severe unstable slops consider open reduction but avascular necrosis is high risk

23
Q

Outcome of SUFE treatment (Surgery)?

A

> AVN (Avascular necrosis):

  • Stable slips (Able to bear weight) have a low risk of AVN
  • Unstable slips (Unable to bear weight) have a high risk of AVN.

> Chondrolysis

> Deformity (Short, externally rotated, limited flexion)

> Early osteoarthritis

> Possiblility of loop on the other side (If there is an endocrine issue sometime the other leg is pinned prophylactically)

> Limb length discrepancy - Pinning through the growth plate can reduce growth (The younger at the time the larger the discrepancy)

> Impingement

24
Q

Why can’t you use Xray to monitor Developmental hip dysplasia, what other imaging modality is used instead?

A

The hip hasn’t ossified prior to 3 months of age. Ultrasound is used instead

25
Q

Management of developmental hip dysplasia - 3 months to 1 year?

A

Closed reduction and spica cast

26
Q

Management of developmental hip dysplasia - >1 year?

A

Over a year open reduction and capsule reefing

27
Q

Management of developmental hip dysplasia - >18 months?

A

Open reduction with femoral shortening +/- Per-acetabular osteotomy

28
Q

Management of developmental hip dysplasia - > 6yrs?

A

Bilateral leave alone

29
Q

Management of developmental hip dysplasia - >10 yrs?

A

Unilateral leave alone

30
Q

If development hip dysplasia isn’t recognised and treated earlier what is likely to occur?

A

Poorer results with an increased risk of AVN (Avascular necrosis)

31
Q

Screening for developmental dysplasia of hip?

A

Clinical examination:

  • Baby relaxed and examined early
  • Examiner experience and has time
  • Does not identify all dysplastic hips

Universal ultrasound screening:

  • Time consuming/massive workload
  • Difficulty in compliance and follow-up
  • Eliminates number of late presenters
  • May not be cost effective

Selective ultrasound screening:

  • Work load manageable
  • Reduces late presentations
  • But late presenters will always occur
32
Q

If a child presents with a pain in the knee how should you manage?

A

Check the hip for developmental hip dysplasia as there is a high risk of Legg-Calve-Perthes Disease

(Same nerve supply)

33
Q

Prognosis of Legg-Calve-Perthes Disease?

A

> Age at presentation, younger od better
Proportion of head involved = More is bad
Herring grade (lateral Pillar classification)
Radiography “head at risk signs” Caterall
The nearer the head is to round the better the outlook (Stulberg)

34
Q

What is used on radiograph to help identify SCFE?

A

Trethowan’s sign - Klein line should have part of the epiphysis above this in SCFE there isn’t.

35
Q

Outcome of SUFE treatment (Surgery) - Avascular necrosis?

A

AVN (Avascular necrosis):
- Stable slips (Able to bear weight) have a low risk of AVN

  • Unstable slips (Unable to bear weight) have a high risk of AVN.

Year 3 - Musculoskeletal (30 decks)

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