paediatric orthopaedics Flashcards
developmental dysplasia of the hip risk factors
- first born
- female
- breech position
- family history
- increased birth weight
- having other congenital disorders
developmental dysplasia of the hip pathophysiology
- occurs when there is dislocation and subluxation of the femoral head from the acetabulum during the prenatal period
- failure to maintain close apposition of the components of the hip joint will result in a shallow acetabulum, altered biomechanics, one limb being shorter than the other and ultimately accelerated osteoarthritis of the affect hip
- more common in left hip
developmental dysplasia of the hip presentation
- limb shortening
- asymmetric groin
- asymmetric skin folds of groin
in developmental dysplasia of the hip ultrasound if
- first degree family history of hip problems in early life
- breech at or after 36 weeks
- multiple pregnancy
what is Ortolani test
- abduction and pressing the hip anteriorly
- positive test if clunking sound is heard due to relocation of the femoral head into the acetabulum
what is Barlow’s test
- adduction and pressing leg posteriorly
- positive test if clicking sound heard due to dislocation of the femoral head
developmental dysplasia of the hip diagnosis
- ultrasound
- if child if > 4.5 months –> x-ray
developmental dysplasia of the hip management 0-6 months
Pavlik’s harness for 3 months
developmental dysplasia of the hip management 6-18 months
closed reduction and 3 month hip spica cast
developmental dysplasia of the hip management > 18 months
open reduction and femoral osteotomy
transient synovitis is most common in
boys aged 2-10
transient synovitis causes
most commonly following on from respiratory viral infection
what is transient synovitis
self limiting inflammation of the synovium of the hip joint
transient synovitis presentation
- limp
- reluctance to weight bear
- restricted range of movement
- low grade fever
transient synovitis diagnosis
- exclusion
- rule out septic arthritis by doing bloods and cultures
transient synovitis management
NSAIDs, rest and review
Perthes disease is most common in
short, active boys 4-9 years old
what is Perthes disease
- idiopathic osteochondritis of the femoral head
- results in transient loss of blood supply to the femoral head and eventually avascular necrosis and abnormal growth
Perthes presentation
- limp
- pain in hip/knee
- usually unilateral
- loss of internal rotation
- loss of abduction
- Trendelenburg gait
Perthes diagnosis
- x-ray showing joint space widening, decreased size of femoral head, collapse and deformity of the femoral head
- if x-ray if normal then MRI
Perthes management
- bed rest, analgesia, avoidance of exercise and regular monitoring
- osteotomy (only indicated if severe subluxation and deformity of the femoral head)
slipped upper femoral epiphysis is most common in
obese boys aged 10-16
what is slipped upper femoral epiphysis
femoral head epiphysis slips inferiorly from neck of femur
slipped upper femoral epiphysis presentation
- limp
- pain (hip, anterior thigh, knee)
- unable to weight bear
slipped upper femoral epiphysis management
surgical stabilisation of the epiphysis (internal fixation)
genu varum causes
- Rickets
- trauma
- osteochondroma
what is genu varum
- pathological amount of varus in the tibia and fibula –> bow legs
- normally resolves by 4
genu valgum causes
- idiopathic
- trauma
- enchondroma
what is genu valgum
- normal legs have small degree of valgus
- pathological amount of valgus in the tibia and fibula –> knock knees
patellofemoral dysfunction is most common in
adolescent girls
patellofemoral pain disorder is most common in
athletes (especially those with recent increase in activity/experiences recent trauma)
patellofemoral pain disorder presentation
anterior knee pain on walking up the stairs or after prolonged periods of sitting
patellofemoral pain disorder management
rest, analgesia and physiotherapy
Osgood Schlatter disease is most common in
boys aged 10-15 years old
what is Osgood Schlatter disease
inflammation of the tibial tuberosity, which is the site of attachment of the patella ligament
Osgood Schlatter disease presentation
- knee pain, history of strenuous activity
- pain worse on contraction of the quadriceps (straight leg raise)
Osgood Schlatter disease management
rest, analgesia and physiotherapy
club foot (talipes equinovarus) cause
develops due to abnormal alignment of the joint between the talus, calcaneus and navicular bones
club foot (talipes equinovarus) risk factors
- male
- family history
- breech position
- low amniotic fluid content during development
club foot (talipes equinovarus) presentation
- plantar flexion of the ankle
- supination of the forefoot
- varus alignment of the forefoot
club foot (talipes equinovarus) management
Ponsetti technique
- regime of serial casts started soon after birth
- most children require Achilles tenotomy
- brace worn 23 hours a day for 3 months and then at night until the age of 3
what is Salter Harris classification type 1
complete separation of the epiphysis
what is Salter Harris classification type 2
complete separation of the epiphysis with a small fragment of metaphysis
what is Salter Harris classification type 3
intra-articular fracture of the epiphysis
what is Salter Harris classification type 4
intra-articular fracture of the epiphysis with a small fragment of metaphysis
what is Salter Harris classification type 5
compression fracture that doesn’t show up on x-ray and is associated with growth arrest and angular deformity
what is a supracondylar fracture
supracondylar area of humerus fracture
supracondylar fracture management
K wires
what is a radial buckle fracture
buckle fractures of radius occurring within the metaphysis
radial buckle fracture cause
arise due to compression of one side of the bone, causing the opposite side to bend away
radial buckle fracture diagnosis
x-ray showing bulge on metaphysis of radius
radial buckle fracture management
splint for 3-4 weeks
what is a Greenstick fracture
incomplete fracture of the diaphysis of the radius
Greenstick fracture cause
arise due to bending of the forearm, with the fracture occurring on the convex side (bulging side)
Greenstick fracture management
cast and closed manipulation if angulated
what is a toddler’s fracture
fracture of the tibia that isn’t displaced
toddler’s fracture presentation
irritable child that is reluctant to weight bear
toddler’s fracture management
cast
