Paediatric Orthopaedic Conditions

Question 1

define juvenile idiopathic arthritis (JIA)

Answer 1

a joint inflammation presenting in children < 16yrs and persisting for > 6wks

Question 2

clinical features of JIA

Answer 2

persistent joint swelling for > 6wks 
salmon pink rash 
high fever 
malaise 
weight loss 
uveitis

Question 3

investigations in JIA

Answer 3

bloods (FBC, CRP, ANA)
XR - rule out malignancy
US - thickened synovium

Question 4

management of JIA

Answer 4

NSAIDs
steroids (intraarticular + oral)
methotrexate 
TNF-a inhibitors 
surgical intervention

Question 5

complications of JIA

Answer 5

pain into adulthood

joint deformities

Question 6

define developmental dysplasia of the hip (DDH)

Answer 6

an abnormality of the hip joint in which the ball of the femur and the acetabulum of the pelvis do not articulate properly

Question 7

risk factors of DDH

Answer 7

female 
first born 
fanny first (breech)
family history of DDH
fluid (oliohydramnios)

Question 8

screening of DDH

Answer 8

Barlow (dislocation - posterior) and Ortalani (relocation on abduction of hip) tests

Question 9

investigations in DDH

Answer 9

hip US

Question 10

management of DDH

Answer 10

mild: self-limiting
severe: Pavlik harness or surgery

Question 11

define Perthe’s Disease

Answer 11

an avascular necrosis of the femoral head in children aged 4-8yrs

Question 12

clinical features of Perthes Disease

Answer 12

gradual onset limp
hip pain and potential knee referral
pain persisting > 4wks

Question 13

investigations of Perthes Disease

Answer 13

hip XR:

can show sclerosis and fragmentation of the epiphysis

Question 14

management of Perthes Disease (< 50% of head involved)

Answer 14

conservative measurements (bed rest and traction)

Question 15

management of Perthe’s Disease (>50% of head involved)

Answer 15

plaster cast for fixed abduction

osteotomy

Question 16

define slipped upper femoral epiphysis (SUFE)

Answer 16

a common hip disorder that occurs when weakness of the proximal femoral growth plate allows displacement of the capital femoral epiphysis

Question 17

clinical features of SUFE

Answer 17

obese adolescent male
insidious onset hip pain and limp
knee pain 
reduced ROM on hip flexion
\+ve Trendelenberg gait

Question 18

risk factors of SUFE

Answer 18

onset of puberty
obesity 
endocrine disorders
male sex
afro-caribbean or hispanic ethnicity 
previous radiotherapy

Question 19

management of unstable SUFE

Answer 19

surgical repair

prophylactic fixation of contralateral hip

Question 20

management of stable SUFE

Answer 20

in-situ screw fixation
prophylactic fixationof contralateral hip
open reduction with internal fixation
bone graft epiphysiodesis

Question 21

investigations of SUFE

Answer 21

plain XR pelvis in AP and frog-leg views