Paediatric Orthopaedic Conditions Flashcards
What is developmental dysplasia of the hip (DDH)?
Dislocation/subluxation of the femoral head during the perinatal period
Give some risk factors for DDH
Female sex Family history Breech birth First born Down's syndrome
Give some signs and symptoms of DDH
Limb shortening
Asymmetric groins
Thigh skin creases
What is a positive Barlow’s test for DDH?
When there is a click on dislocating the hip with flexion
What is a positive Ortolani’s test for DDH?
When there is a click on reducing a dislocated hip with abduction
What investigations are used for DDH?
Ultrasound - from 0 to 4-6 months
X-ray - from 4-6 months onward
How is DDH mainly treated?
Pavlik harness - keeps hips in comfortable flexion and abduction
What is the commonest cause of hip pain in children?
Transient synovitis
What is transient synovitis?
Self-limiting synovial inflammation following a viral URTI
Give some signs and symptoms of transient synovitis
Pain Limp Reluctance to weight bear Reduced motion Low grade fever
How is transient synovitis treated?
NSAIDs and rest
What is Perthes disease?
An idiopathic osteochondritis of the femoral head leading to AVN and collapse
Who does Perthes tend to affect?
Very active and short boys aged 4-9
Give some signs and symptoms of Perthes
Pain and limp
Loss of internal rotation and abduction
Positive Trendellenburg test
How is Perthes treated?
X-ray observation
Avoid physical activity
What is slipped upper femoral epiphysis (SUFE)?
When the femoral head epiphysis slips inferiorly compared to the femoral neck
Who does SUFE affect?
Overweight pre-pubertal adolescent boys
Give some signs and symptoms of SUFE
Pain and limp Knee pain (so examine hip) Loss of hip internal rotation
How is SUFE treated?
Pinning the femoral head to prevent slippage
Osgood-Schlatter’s disease is an inflammation of what?
Tibial tubercle apophysis
What occurs in osteochondritis dissecans?
When a fragment of hyaline cartilage with bone fragments break off the joint surface
What are some signs and symptoms of osteochondritis dissecans?
Poorly localised pain
Effusion
Locking
What is the main investigation for osteochondritis dissecans?
MRI
How is osteochondritis dissecans treated?
Surgical removal of fragments
How is talipes equinovarus better known?
Clubfoot
What is the pathogenesis of talipes equinovarus?
Abnormal alignment of joints between talus, calcaneus and navicular causing contractures of soft tissue
What are the signs of clubfoot?
Ankle equinus (plantarflexion)
Forefoot supination
Varus forefoot
Give some risk factors for clubfoot
Male sex
Positive family history
Breech position
Low amniotic fluid content
How is clubfoot treated?
Ponseti splintage
Achilles tendon tenotomy
What is scoliosis?
Lateral curvature of the spin
How is painful scoliosis imaged?
MRI
What is spondylolisthesis?
Slippage of one vertebrae over another
Where does spondylolisthesis commonly occur?
L4/L5
L5/S1
Give some signs and symptoms of spondylolisthesis
Adolescents
Increased body weight
Increased sporting activity
Waddling gait
How is spondylolisthesis treated?
Minor slippage - rest and physiotherapy
Severe slippage - stabilisation
