Paediatric Orthopaedic Conditions Flashcards
define juvenile idiopathic arthritis (JIA)
a joint inflammation presenting in children < 16yrs and persisting for > 6wks
clinical features of JIA
persistent joint swelling for > 6wks salmon pink rash high fever malaise weight loss uveitis
investigations in JIA
bloods (FBC, CRP, ANA)
XR - rule out malignancy
US - thickened synovium
management of JIA
NSAIDs steroids (intraarticular + oral) methotrexate TNF-a inhibitors surgical intervention
complications of JIA
pain into adulthood
joint deformities
define developmental dysplasia of the hip (DDH)
an abnormality of the hip joint in which the ball of the femur and the acetabulum of the pelvis do not articulate properly
risk factors of DDH
female first born fanny first (breech) family history of DDH fluid (oliohydramnios)
screening of DDH
Barlow (dislocation - posterior) and Ortalani (relocation on abduction of hip) tests
investigations in DDH
hip US
management of DDH
mild: self-limiting
severe: Pavlik harness or surgery
define Perthe’s Disease
an avascular necrosis of the femoral head in children aged 4-8yrs
clinical features of Perthes Disease
gradual onset limp
hip pain and potential knee referral
pain persisting > 4wks
investigations of Perthes Disease
hip XR:
can show sclerosis and fragmentation of the epiphysis
management of Perthes Disease (< 50% of head involved)
conservative measurements (bed rest and traction)
management of Perthe’s Disease (>50% of head involved)
plaster cast for fixed abduction
osteotomy
define slipped upper femoral epiphysis (SUFE)
a common hip disorder that occurs when weakness of the proximal femoral growth plate allows displacement of the capital femoral epiphysis
clinical features of SUFE
obese adolescent male insidious onset hip pain and limp knee pain reduced ROM on hip flexion \+ve Trendelenberg gait
risk factors of SUFE
onset of puberty obesity endocrine disorders male sex afro-caribbean or hispanic ethnicity previous radiotherapy
management of unstable SUFE
surgical repair
prophylactic fixation of contralateral hip
management of stable SUFE
in-situ screw fixation
prophylactic fixationof contralateral hip
open reduction with internal fixation
bone graft epiphysiodesis
investigations of SUFE
plain XR pelvis in AP and frog-leg views
