Paediatric Orthopaedics Flashcards
Pain medication in children
Codeine and tramadol are not used in children as they are unpredicatble in their metabolism
Aspirin is not used in children younger than 16 yo due to Reye’s syndrome
Differentials for a limp
0 - 4 years:
- Transient synovitis
- Septic arthritis
- Developmental dysplasia of the hip
5 - 10 years
- Perthe’s disease
- Transient synovitis
10 - 16 yo
- Juvenile idiopathic arthritis
- Slipper upper femoral epiphysis
Presentation of hip pain
Limp Not bearing weight on affected side Delayed walking Pain Swollen and tender joint
Red flags for hip pain
Children under 3 yo Fever Waking at night with pain Weight loss and anorexia Night sweats Fatigue Persistent pain Stiffness in the morning Swollen or red joint
When to urgently refer a limping child
Children under 3 yo Child > 9 yo with a restricted or painful hip Unable to weight bear Neurovascular compromise Severe pain Suspicion of abuse
Investigations for hip pain
Bloods - CRP, FBC Xray - fracture, SUFE USS - effusion Joint aspiration - sepsis MRI - osteomyelitis
Causative organisms for septic arthritis
Staphylococcus aureus - most common Neiserris gonorrhoea Streptococcus pyogenes Haemophilus influenzae E. Coli
Management of septic arthritis
Antibiotics dependent on joint aspirate culture for 3 - 6 weeks
Surgicsl drainage and washout
Transient synovitis pathophysiology
Inflammation of the synovial membrane associated with a recent viral upper respiratory tract infection
What age range does transients synovitis typically affect
3 - 10 yo
Presentation of transient synovitis
- after viral URTI - coryzal symptoms
- limp
- refusal to weight bear
- joint pain
- low fever
Management of transient synovitis
Exclude septic arthritis
Symptomatic relief - analgesia
Can be managed in primary care if 3 - 9yo and limp present within 48 hours whilst systemically well
Prognosis of transient synovitis
Significant improvement after 24 - 48 hours
Symptoms fully resolve within 1 - 2 weeks without any lasting problems
Perthes disease pathophysiology
Avascular necrosis of the femoral head
Who does perthes disease typically affect?
Children aged 4 - 12 yo
Commonly between 5 - 8 yo boys
Complication of perthes disease
Early osteoarthritis of the the hip
Presentation of perthes disease
Pain in the hip or groin
Limp
Restricted hip movements
Referred pain to the knee
Investigations for perthes disease
Bloods - normal
Technetium bone scan
MRI scan
Management of Perthes disease
Under 6 yo mild to moderate disease - supportive:
- bed rest and analgesia
- traction
- crutches
- physiotherapy
- regular xrays - monitoring
Severe disease > 6yo - surgery
Slipper upper femoral epiphysis pathophysiology
Head of the femur is dispaced along the growth plate
Who does SUFE typically affect
Obese boys aged 8 - 15yo
Presentation of SUFE
- hip, groin, thigh or knee pain
- restricted hip movement - inability to internally rotate
- painful limp
Investigations for SUFE
Bloods - usually normal
Technetium bone scan
CT scan
MRI scan
Management of SUFE
Surgery - cannulated screws
