Paediatric Orthopaedic Conditions

Question 1

What is developmental dysplasia of the hip (DDH)?

Answer 1

Dislocation/subluxation of the femoral head during the perinatal period

Question 2

Give some risk factors for DDH

Answer 2

Female sex
Family history
Breech birth
First born
Down's syndrome

Question 3

Give some signs and symptoms of DDH

Answer 3

Limb shortening
Asymmetric groins
Thigh skin creases

Question 4

What is a positive Barlow’s test for DDH?

Answer 4

When there is a click on dislocating the hip with flexion

Question 5

What is a positive Ortolani’s test for DDH?

Answer 5

When there is a click on reducing a dislocated hip with abduction

Question 6

What investigations are used for DDH?

Answer 6

Ultrasound - from 0 to 4-6 months

X-ray - from 4-6 months onward

Question 7

How is DDH mainly treated?

Answer 7

Pavlik harness - keeps hips in comfortable flexion and abduction

Question 8

What is the commonest cause of hip pain in children?

Answer 8

Transient synovitis

Question 9

What is transient synovitis?

Answer 9

Self-limiting synovial inflammation following a viral URTI

Question 10

Give some signs and symptoms of transient synovitis

Answer 10

Pain
Limp
Reluctance to weight bear
Reduced motion
Low grade fever

Question 11

How is transient synovitis treated?

Answer 11

NSAIDs and rest

Question 12

What is Perthes disease?

Answer 12

An idiopathic osteochondritis of the femoral head leading to AVN and collapse

Question 13

Who does Perthes tend to affect?

Answer 13

Very active and short boys aged 4-9

Question 14

Give some signs and symptoms of Perthes

Answer 14

Pain and limp
Loss of internal rotation and abduction
Positive Trendellenburg test

Question 15

How is Perthes treated?

Answer 15

X-ray observation

Avoid physical activity

Question 16

What is slipped upper femoral epiphysis (SUFE)?

Answer 16

When the femoral head epiphysis slips inferiorly compared to the femoral neck

Question 17

Who does SUFE affect?

Answer 17

Overweight pre-pubertal adolescent boys

Question 18

Give some signs and symptoms of SUFE

Answer 18

Pain and limp
Knee pain (so examine hip)
Loss of hip internal rotation

Question 19

How is SUFE treated?

Answer 19

Pinning the femoral head to prevent slippage

Question 20

Osgood-Schlatter’s disease is an inflammation of what?

Answer 20

Tibial tubercle apophysis

Question 21

What occurs in osteochondritis dissecans?

Answer 21

When a fragment of hyaline cartilage with bone fragments break off the joint surface

Question 22

What are some signs and symptoms of osteochondritis dissecans?

Answer 22

Poorly localised pain
Effusion
Locking

Question 23

What is the main investigation for osteochondritis dissecans?

Answer 23

MRI

Question 24

How is osteochondritis dissecans treated?

Answer 24

Surgical removal of fragments

Question 25

How is talipes equinovarus better known?

Answer 25

Clubfoot

Question 26

What is the pathogenesis of talipes equinovarus?

Answer 26

Abnormal alignment of joints between talus, calcaneus and navicular causing contractures of soft tissue

Question 27

What are the signs of clubfoot?

Answer 27

Ankle equinus (plantarflexion)
Forefoot supination
Varus forefoot

Question 28

Give some risk factors for clubfoot

Answer 28

Male sex
Positive family history
Breech position
Low amniotic fluid content

Question 29

How is clubfoot treated?

Answer 29

Ponseti splintage

Achilles tendon tenotomy

Question 30

What is scoliosis?

Answer 30

Lateral curvature of the spin

Question 31

How is painful scoliosis imaged?

Answer 31

MRI

Question 32

What is spondylolisthesis?

Answer 32

Slippage of one vertebrae over another

Question 33

Where does spondylolisthesis commonly occur?

Answer 33

L4/L5

L5/S1

Question 34

Give some signs and symptoms of spondylolisthesis

Answer 34

Adolescents
Increased body weight
Increased sporting activity
Waddling gait

Question 35

How is spondylolisthesis treated?

Answer 35

Minor slippage - rest and physiotherapy

Severe slippage - stabilisation