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Child Health > Paediatric Orthopaedics > Flashcards

Paediatric Orthopaedics Flashcards

1
Q

What is Developmental Dysplasia of the Hip?

A

Developmental dysplasia of the hip

Represent a spectrum of hip instabilities

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2
Q

What are the types of Developmental Dysplasia of the Hip?

A

Typical - affect normal infants

Teratological - occur in neurological and genetic conditions (req. specialised management)

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3
Q

Detail the epidemiology of Developmental Dysplasia of the Hip

A

1-3% of newborns
More often left hip
20% bilateral

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4
Q

What are some risk factors for Developmental Dysplasia of the Hip?

A 
Female
Born breech - inc. C Section
Birth weight >5kg
Family history
First born child
Oligohydramnios - restricted movement
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5
Q

Why has Developmental Dysplasia of the Hip changed its name? (bit of a pointless card)

A

Used to be congenital hip dysplasia

Changed name as it can occur after birth in normal hips
Stops us getting sued

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6
Q

How does Developmental Dysplasia of the Hip present?

A 
Limited abduction
Leg length discrepancy
Asymmetrical gluteal/thigh skin folds
Delayed walking
Painless limp
Waddling gait
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7
Q

How is Developmental Dysplasia of the Hip commonly picked up?

A

At the 6-8 week screening using Ortolani and Barlow manoeuvres

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8
Q

What does Barlow’s manoeuvre do?

A

Attempt to dislocate articulated femoral head - apply backward pressure to each femoral head

Subluxable hip is suspected on basis of palpable partial or complete dislocation

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9
Q

What happens in Ortolani’s manoeuvre?

A

Attempt to relocate dislocated femoral head - forward pressure to each femoral head

Positive test if clunk heard when relocating femoral head

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10
Q

What is done if Developmental Dysplasia of the Hip is suspected following Ortolani’s and Barlow’s?

A

USS <4.5 months

Hip X-Ray

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11
Q

When do hip X-Rays become useful?

A

After 4-5 months - once femoral head ossified

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12
Q

What are the complications associated with Developmental Dysplasia of the Hip?

A

Re-dislocations
Avascular necrosis
Degenerative joint disease

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13
Q

How is Developmental Dysplasia of the Hip managed in children under 6 weeks of age?

A

Wait to see if spontaneously resolve

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14
Q

How is Developmental Dysplasia of the Hip managed in children <5 months old?

A

Pavlik harness - flexion and abduction to keep head in acetabular fossa

Must be adjusted every 2 weeks

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15
Q

What may be required for older children with Developmental Dysplasia of the Hip?

A

Surgery

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16
Q

What is galeazzi’s test?

A

Flex infant’s knees when lying down so feet touch the surface and the ankles touch the buttocks

If knees at different heights - suggest DDH

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17
Q

What is Perthes’ disease?

A

Idiopathic disorder resulting in avascular necrosis of the femoral head. Bone remodelling leads to a flattened and enlarged head

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18
Q

What part of the femoral head is specifically affected in Perthes’ disease?

A

Femoral epiphysis

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19
Q

How long does the cycle of Perthes’ disease take? (from avascular necrosis to remodelling)

A

3-4 years

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20
Q

What risk factors are associated with Perthes’ disease?

A

Boys
4-8yo
Family history

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21
Q

How would Perthes’ disease present?

A

Insidious onset of limp
Stiffness and reduced range of motion
Pain can be intermittent - groin, thigh or knee

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22
Q

How is Perthes’ disease diagnosed?

A

X-Ray changes

1 Widened joint space
2 Small flat femoral head

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23
Q

How is Perthes disease managed?

A

<6yo - observe

>6yo - cast, braces and possible surgical intervention

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24
Q

What complications are associated with Perthes’ disease?

A

Osteoarthritis

Premature fusion of growth plates

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25
Q

What is osteomyelitis?

A

Inflammation of the bone marrow due to infection

It may spread to the cortex and periosteum via Haversian canals

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26
Q

What can happen if the periosteum is involved in osteomyelitis?

A

Can become necrosed

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27
Q

Where is osteomyelitis likely to affect in children?

A

Distal femur

Proximal tibia

28
Q

When do children commonly get osteomyelitis?

A

Neonatal period

9-11 yo

29
Q

What commonly causes osteomyelitis?

A

Mostly staph aureus

Can be H Influenzae, Group B Strep or E Coli (neonates)

Sickle cell - salmonella osteomyelitis

30
Q

How do children get osteomyelitis?

A

Haematological spread from remote source

Direct contact with infection - trauma

31
Q

How does osteomyelitis present?

A

Acutely febrile and bacteraemic

Painful, immobile lower limb

Swelling, erythema, warm tender limb

Pain worse on movement

32
Q

How is osteomyelitis diagnosed?

A

FBC - acute phase reactants (CRP, WBC, ESR) elevated
Culture - blood. and bone
MRI

33
Q

How is osteomyelitis managed?

A

Surgical debridement

4-6 weeks flucloxacillin

34
Q

What is septic arthritis?

A

Purulent infection of a joint space that can result in bone destruction and considerable disability

35
Q

When is incidence of septic arthritis highest?

A

<3yo

36
Q

What can cause septic arthritis?

A

Staph Aureus

Haematogenous origin
Osteomyelitis
Infected skin lesions
Puncture wounds

37
Q

Where does septic arthritis most commonly affect?

A

Infants - hip

Older children - knee

38
Q

How does septic arthritis present?

A 
Often no localising signs
Pain on active and passive movement
Fever and acutely bacteraemic
Limp
Swollen warm joint
Refuse to weight bear
Infants often hold limb rigid
39
Q

How is septic arthritis investigated?

A

FBC - CRP, WCC, ESR raised
Culture
Synovial fluid examination - leukocyte count, gram stain, culture

USS - effusion
Can use MRI/CT

40
Q

How is septic arthritis managed?

A

Surgical drainage - if recurrent or affect hip

3 weeks IV flucloxacillin then oral for 2 weeks

41
Q

What is the most common cause of hip pain in children?

A

Transient synovitis

42
Q

Between what ages do children typically get transient synovitis?

A

3-8 years old

43
Q

What causes transient synovitis?

A

Inflammation of the synovium

44
Q

How does transient synovitis present?

A 
Post viral infection
Hip, groin and thigh pain
Reluctant to weight bear
Passive movements painful at extreme range of motion
Low grade fever but systemically well
45
Q

What must be excluded if you consider transient synovitis as a diagnosis?

A

Septic arthritis

46
Q

How would you investigate transient synovitis?

A

FBC - inflammatory markers
Blood cultures
Xray - frog, lateral and AP (can see increased joint space)
USS and MRI - may show joint effusion and thickened synovium

47
Q

How is transient synovitis managed?

A

Self limiting - resolve within week

Supportive measures - analgesia, avoid strenuous activity

48
Q

If a child comes in with a limp, what differentials would you consider?

A 
Transient synovitis
Septic arthritis
Osteomyelitis
Juvenile idiopathic arthritis
Trauma
DDH
Perthes disese
Slipped upper femoral epiphysis
49
Q

What history would point to a limp being due to transient synovitis?

A

Acute onset
Accompanying viral infection - child only have mild fever
Boy 2-12 yo

50
Q

What would point to a limp being due to septic arthritis or osteomyelitis?

A

High fever

Unwell child

51
Q

What would point to a limp being due to juvenile idiopathic arthritis?

A

Limp painless

52
Q

What would point to Developmental Dysplasia of the Hip as the cause for a limp?

A

Detected in neonates

6x more common in girls

53
Q

What would point to Perthes disease as the cause for a limp?

A

4-8 yo

Avascular necrosis of femoral head

54
Q

What happens in Slipped Upper Femoral Epiphysis?

A

Displacement of femoral head epiphysis postero-inferiorly

10-15yo

Mostly obese boys

55
Q

What features of a limp would require urgent same day assessment?

A 
<3yo 
>9yo with reduced ROM particularly internal rotation
Not weight beating
Severe pain
Neurovascular compromise
Waking at night in pain
Night sweat
Weight loss
Fever
56
Q

What happens in rickets?

A

Inadequate mineralisation of bone matrix before closure of growth plates

57
Q

What are causes of Rickets?

A 
Lack of sunlight
Reduced Vit D in diet
Malabsorption
Liver disease
Renal disease
Anticonvulsants
Lack of dietary calcium
58
Q

What are some key risk factors for rickets?

A

Dark skin
Vegetarian
Exclusively breast fed beyond 6 months

59
Q

Where do we get vitamin d?

A

90% sunlight

10% diet - oily fish, liver, egg yolk

60
Q

What features are indicative of rickets?

A 
Delayed closure of fontanelles
Frontal bossing
Dental hypoplasia
Pectus carinatum
Swelling in wrist and ankles
Wide sutures
Craniotabes
Rachitic rosary
Harrison's sulcus
Bowing of legs
Delayed growth
Waddling gait and pain
61
Q

What is rachitic rosary?

A

Prominent knobs of bone at the costochondral joints

Can lead to chest infections

62
Q

What is Harrisons’s sulcus?

A

Horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm

63
Q

How is Rickets diagnosed?

A

Wrist X-Ray - metaphysical cupping, fraying and splaying

64
Q

How would you investigate rickets?

A

LFT
U&E
FBC - anaemia - malabsorption
Calcium, phosphate, PTH

65
Q

How is rickets managed?

A

Normalise within 3 months of treatment
Oral calciferol
Calcium supplements
Advice on sun and diet

Child Health (30 decks)

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