Paediatric Orthopaedics Flashcards

1
Q

Who gets DDH?

A

G > B 6:1

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2
Q

What does DDH stand for?

A

Developmental dysplasia of the hip

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3
Q

Which side of the hip is more commonly affected by?

A

Left hip 3:1

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4
Q

Increased incidence of DDH in….

A

Oligohydramnios
First born
Breech presentation (legs pushed together)
FH
other lower limb deformities
**ALL DUE TO BEING SQUISHED INTO A SMALL SPACE ****

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5
Q

What is oligohydramnios?

A

Lack of amniotic fluid

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6
Q

Clinical features of DDH

A
Ortolanis sign 
Barlows sign 
Piston motion sign 
***Only 40% 
Unequal skin folds / leg length
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7
Q

What is ortolani’s sign?

A

Hip can be dislocated

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8
Q

What is barlow’s sign?

A

The hip can be put back into place

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9
Q

What is the piston motion sign?

A

If the hip isn’t in the joint, it can move anywhere without anything stopping

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10
Q

Diagnosis of DDH

A

USS up to 1 y/o

Examination (only 40% picked up)

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11
Q

Treatment of DDH

A

Abduction brace

Surgical treatment if hip completely out

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12
Q

What does an abduction brace do?

A

Reduces the chance of progression

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13
Q

Who gets LCP?

A

M > F 5:1

Primary school age

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14
Q

What does LCP mean?

A

Legg-Calve Perthes Disease

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15
Q

Presentation of LCP

A
15% Bilateral 
short stature
limp 
knee pain on exercise 
stiff hip joint
systemically well
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16
Q

Phases of LCP

A

Avascular necrosis
Fragmentation (revascularisation -> pain)
reossification (bony healing)
Residual deformity

17
Q

Differential diagnosis of LCP

A
Unilateral 
- septic hip 
- JIA
- SCFE
- lymphoma
Bilateral 
- hypothyroid
- sickle
- epiphyseal disease
18
Q

Treatment of LCP

A

maintain hip motion
Analgesia
Restrict painful activities
‘Supervised neglect’ in most cases - nothing we can do
‘containment’
- consider osteotomy in selected groups > 7 y/o

19
Q

Prognosis of DDH

A

Good if onset < 9 y/o

20
Q

What does SCFE stand for?

A

Slipped capital femoral epiphysis

21
Q

Who gets SCFE/SUFE?

A

Boys > girls

9-14 y/o

22
Q

How many cases of SCFE become bilateral?

A

20%

23
Q

Classification of SCFE/SUFE

A

acute vs chronic (3 weeks)
stable vs unstable
- unstable needs fixed (serendipitus reduction)
- stable = possibly fix in situ

24
Q

Diagnosis of SCFE

A

Examination
X ray
- relative to width femoral neck on AP film

25
Q

Presentation of SCFE

A

Pain in hip and knee
Externally rotated posture and gait
Foot externally rotates and shortens
Reduced internal rotation, especially in flexion

26
Q

Pathology of SCFE

A

Displacement through hypertrophic zone

metaphysis moves anterior and proximal

27
Q

Treatment of SCFE

A

Surgery

28
Q

Complications of SCFE

A

Avascular necrosis (AVN)
Chondrolysis (death of cartilage)
Deformity
Early OA

29
Q

Features of myopathies

A

Symmetrical muscle weakness (proximal > distal)
Common problems arise when rising out of chair / bath
Sensation and reflexes normal
No fasiculations

30
Q

Causes of myopathies

A
Polymyositis
Duchennes/Beckers muscular dystrophy 
Myotonic dystrophy 
Cushings
Thyrotoxicosis
Alcohol