Paediatric Orthopaedics Flashcards
What is Perthe’s disease? Who does it most commonly affect?
Disruption of the blood flow to the femoral head - leads to avascular necrosis
Boys aged 4-8
What is the long-term affect of Perthe’s disease?
Over time, re-vascularisation of the femoral head leads to early hip osteoarthritis
How does Perthe’s disease present?
Gradual onset of…
Pain in the hip/groin
Limping
Restricted hip movement
How is Perthe’s disease diagnosed?
XR may be normal but can show sclerosis and fragmentation
May also show widening of joint space and decreased femoral head size
If XR is normal can do an MRI
How is Perthe’s disease managed?
If less than 50% of the femoral head is affected - conservative management
If more than 50% affected - plaster cast
May need surgical management
What is developmental hip dysplasia?
Structural abnormality of the hips
Caused by abnormal development of fetal bones during pregnancy
Tendency for dislocation
What are risk factors for developmental hip dysplasia?
1st degree family history
Breech presentation from 36 weeks
Breech presentation at birth
Multiple pregnancy
What 2 special tests can be used to diagnose developmental hip dysplasia?
Ortolani test
Barlow test
How is developmental hip dysplasia managed?
<6 months = Pavlik harness
> 6 months = surgery
What is Rickets?
Defective bone mineralisation caused by a deficiency of vitamin D or calcium, leading to soft/deformed bones due to secondary hyperparathyroidism
What are risk factors for Rickets?
Dark skin
Colder climate
Spend a lot of time indoors
What are symptoms of Rickets?
Lethargy
Bone pain
Bone deformity
Poor growth
may be symptoms of high serum calcium - stones
What bone deformities are seen in Rickets?
Bowing of legs
Knock knees
Rachitic rosary
What blood tests should be conducted in suspected Rickets?
Serum 25-hydroxyvitamin D
Low calcium
Low phosphate
Increased ALP
Increased PTH
How is Rickets managed?
Vitamin D supplementation
What is Achondroplasia? What is the hereditary pattern?
Most common cause of dwarfism
Autosomal dominant
What are features of Achondroplasia?
Short limbs + short digits
Normal trunk length
Large head
Flattened mid-face + nasal bridge
Foramen magnum stenosis
What is osteogenesis imperfecta? How does it present?
A genetic condition causing brittle bones which are prone to fracture
Recurrent inappropriate fractures
Blue/grey sclera
Hypermobility
Deafness
Dental imperfections
What is slipped upper femoral epiphysis? How does it present?
When the head of femur slips along the growth plate
More common in obese children
May be some trauma that triggered onset of symptoms
Pain is disproportionate to severity of trauma
Restricted range of movement - Loss of internal rotation
Painful limp
How is slipped capital femoral epiphysis diagnosed?
AP and lateral Xrays
How is slipped capital femoral epiphysis managed?
Internal fixation with a single cannulated screw
What is transient synovitis? How does it present?
Acue hip pain following a recent viral infection
Limp/inability to weight bear
Groin/hip pain
Low grade fever
Self-limiting
When might you consider septic arthritis over transient synovitis?
High grade fever warrants investigation for septic arthritis
