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Paediatric orthopaedics Flashcards

1
Q

What hip problems can happen 0-5yrs?

A 
Normal variant
Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
DDH
JIA
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2
Q

What hip problems can happen 5-10yrs?

A 
Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
Legg-Calve-Perthes disease
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3
Q

What hip problems can happen 10-15yrs?

A 
Trauma
Osteomyelitis
Septic arthritis
SUFE
Chondromalacia
Neoplasm
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4
Q

What are the big three orthopaedic paediatric conditions?

A

DDH - developmental dysplasia of the hip
Perthes Disease
SUFE - slipped capital femoral epiphysis

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5
Q

Which part of the world more commonly sees DDH?

A

Eastern Europe

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6
Q

What sex is more commonly affected by DDH?

A

Females

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7
Q

Which hip is more affected by DDH?

A

Left hip

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8
Q

What are risk factors for DDH?

A 
First born
Oligohydramnios
Breech presentation
FHx
Other lower limb deformities
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9
Q

What is oligohydramnios?

A

Amniotic fluid volume that is less than expected for gestational age

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10
Q

What signs are present in DDH?

A

Ortolani’s sign
Barlow’s sign
Piston Motion sign

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11
Q

What is Ortolani’s sign?

A

The palpable sensation of the femoral head slipping into the acetabulum, sometimes with a clunk

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12
Q

What is Barlow’s sign?

A

Performed byadductingthe hip (bringing the thigh towards the midline) while applying pressure on the knee, directing the force posteriorly
If the hip is dislocatable, the test is considered positive

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13
Q

What is the Piston Motion sign?

A

Supine position, flex knee and hip to 90’, femur is pushed down and lifted up
Normal hip, nothing happens
Positive: excessive movement e.g. pistoning

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14
Q

What is the management for DDH?

A

Pavlik harness
Closed reduction of hip then SPICA cast
Open reduction

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15
Q

When should US be used instead of Ortolani’s or Barlow’s sign?

A

At >3 months of age, as Barlow’s and Ortolani’s tests are unreliable

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16
Q

What is Legg-Calve-Perthes disease?

A

Childhood hip disorder that results in avascular necrosis of the femoral head

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17
Q

What sex does Perthes disease affect more?

A

Males

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18
Q

What are does Perthes disease present?

A

Primary school age

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19
Q

What are signs of Perthes disease?

A 
Short stature
Limp
Knee pain on exercise
Stopp hip joint
Systemically well
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20
Q

What is the gait like in Perthes disease?

A

Antalgic gait

Trendelenberg gait

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21
Q

What is an antalgic gait?

A

A gait that develops as a way to avoid pain while walking

The stance phase of gait is abnormally shortened relative to the swing phase

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22
Q

What is a Trendelenburg gait?

A

Abnormal gait (as with walking) caused by weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus

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23
Q

What is the pathology of Perthes disease?

A

Disruption of blood supply causing avascular necrosis of the femoral head
Subsequent revascularization which causes reabsorption of the bone and collapse of the femoral head

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24
Q

What are differentials for unilateral Perthes disease?

A

Septic hip
JIA
SCFE
Lymphoma

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25
What are differentials for bilateral Perthes disease?
Hypothyroid Sickle Epiphyseal dysplasia
26
What is the treatment for Perthes disease?
Maintain hip motion/restore ROM Analgesia: NSAIDs Traction, crutches, physio Osteotomy sometimes in older patients with severe disease
27
What are the investigations for Perthes disease?
XR Bone scan MRI Bloods - will be normal
28
What is SCFE?
Slipped capital femoral epiphysis = the head of the femur ‘slips’ out of alignment due to shearing forces across the growth plate
29
What sex does SCFE affect more?
Males
30
What are the classifications of SCFE?
Acute vs chronic | Stable vs unstable
31
When is SCFE chronic?
3wks
32
What are the signs/symptoms of SCFE?
Pain in hip or knee Externally rotated posture & gait Reduced internal rotation, especially in flexion Antalgic gait
33
What are the investigations for SCFE?
XR - lateral view
34
What are the risk factors for SCFE?
Obesity/high BMI (strain on growing femur) Trauma Male Endocrine disorders
35
What is the management of SCFE?
Surgery
36
What is the pathology of SCFE?
Capital femoral physis is displaced from the metaphysis | Due to mechanical forces on a susceptical physis
37
What are complications of SCFE?
AVN Chrondrolysis Deformity Early OA
38
What type of SCFE has a higher risk of AVN?
Unstable slips - unable to bear weight
39
What line is broken in a dislocated hip?
Shenton line
40
At what age are knock knees normal?
2-7yrs
41
At what age is bow leg common?
<2yrs
42
At what age is symmetrical physiological varus legs normal?
<18mo
43
At what age is symmetrical physiological valgus legs normal?
18m-7yrs
44
What is the mean walking age?
12mo
45
What are causes for intoeing and tripping?
Femoral anteversion Int. tibial torsion Metatarsus adductus
46
Is femoral anteversion normal?
Developmental norm
47
What is internal tibial torsion?
Increased thigh foot angle
48
What is the treatment for internal tibial torsion?
90% resolve sponatneously Splints Wedges Insoles
49
Are flexible flat feet normal at birth?
Yes
50
What is the normal prognosis for flexible flat feet?
Diminishes with age | Asymptomatic
51
Are curly toes normal?
Yes
52
What are ways of performing gait analysis?
Observational Video equipment 3D instrumented
53
What is normal gait?
Series of rhythmical, alternating movements of the trunk and limbs which result in forward progression of centre of gravity
54
When does the gait cycle begin?
When reference foot contacts the ground
55
When does the gait cycle end?
Subsequent floor contact of the same foot
56
What is step length?
Distance between corresponding successive points of heel contact of the opposite feet
57
What is stride length?
Distance between successive points of heel contact of the same foot
58
How do the step length and stride length compare in normal gait?
Stride length is double step length
59
What is the walking base?
Side-to-side distance between the line of the two feet
60
What is cadence?
No steps per unit time
61
What is normal cadence?
100-115 steps/min
62
What are the two phases of the gait cycle?
1) Stance phase | 2) Swing phase
63
What are the components of the stance phase of the gait cycle?
1) Heel contact 2) Foot-flat 3) Midstance 4) Heel-off 5) Toe-off
64
What are the components of the swing phase of the gait cycle?
1) Acceleration 2) Midswing 3) Deceleration
65
Which phase of the gait cycle is usually longer?
Stance phase
66
Where is centre of gravity typically?
Midway between hips, few cm infront of S2
67
What are the forces that have the most influence on gait due to?
Gravity Muscular contraction Inertia Floor reaction
68
What are common gait abnormalities?
``` Antalgic gait Lateral trunk tilt - Trendelenburg Function leg-length discrepancy Increased walking base Inadequate dorsiflexion control Excessive knee extension ```
69
What happens in antalgic gait?
Stance phase on affected side is shortened Increase in stance phase on unaffected side Common: OA, tendinitis
70
What side is lateral trunk tilt/Trendelenberg gait usually?
Usually unilateral | Bilateral = waddling gait
71
What are common causes of Trendeleberg gait?
Painful hip Hip abductor weakness Leg-length discrepancy Abnormal hip joint
72
What are 4 common compensations for functional leg-length discrepancy?
Circumduction Hip hiking Steppage Vaulting
73
What are common causes of increased walking base?
Deformities: abducted hip, valgus knee Instability: cerebellar ataxia, proprioception deficits
74
What happens in inadequate dorsiflexion control?
In stance phase: foot slap | In swing phase: toe drag
75
What are causes of inadequate dorsiflexion control?
Weak tibialis anterior | Spastic plantarflexors
76
What happens in excessive knee extension?
Loss of normal knee flexion during stance phase | Knee may go into hyperextension
77
What are common causes of excessive knee extension?
Quadriceps weakness/spasticity | Knee flexor weakness
78
What are the 5S's for joints?
``` Symptoms Symmetry Stiffness Syndromes Systemic illness ```
79
If there is knee pain what else should you think about?
Hips
80
If there is night pain what should you consider?
Infection or tumour
81
What is the commonest cause of death in children?
Trauma
82
What are the fracture principle's for management in children?
Fixation not usually required Do not over immobilise Do not over treat
83
What is it important to know in fractures involving physes?
Can result in progressive deformity
84
What is a Galeazzi fracture?
Fracture of distal third of the radius with dislocation of the distal radioulnar joint
85
What is a Monteggia fracture?
Fracture of the distal third of the ulnawith dislocation of the proximal head of the radius
86
What % of paeds fractures are forearm?
25-50%
87
Where are more of the fractures of the forearm in paeds?
Distal radial fractures
88
How many degrees can you normally supinate?
85'
89
How many degrees can you normally pronate?
75'
90
What are the options for treatment of paeds fractures?
Open vs closed treated
91
What are indications for surgery?
Open fracture Segmental NV compromise Failed closed Rx
92
What is ORIF?
Open reduction internal fixation
93
What are complications of fracture management?
``` Compartment syndrome Nonunion Refracture Radioulnar synostosis PIN injury Superficial radial nerve injury DRUJ/radiocapitellar problems ```
94
What is a distal radius buckle (torus) fracture?
Common injury in children. It is often caused from falling on the hand. This fracture causes one side of the bone to bend, but does not actually break through the bone.
95
What is a greenstick fracture?
A fracture in a young, soft bone in which the bone bends and breaks
96
What is the management of buckle, greenstick and complete fractures?
Cast
97
What is the risk for remanipulation of fractures?
Complete fractures | Failed anatomic reduction
98
What are the differentials for knee trauma?
``` Infection Inflammatory arthropathy Neoplasm Apophysitis Hip/foot Sickle Haemophilia ```
99
What are types of bony injury of the knee?
``` Physeal/metaphyseal Tibial spine Tibial tubercle Patellar fracture Sleeve fracture Patellar dislocation Referred ```
100
What are paediatric overuse injuries?
Osgood-Schlatter's disease | Sever's disease
101
What are differentials for the acute limping child?
Transient synovitis Osteomyelitis Septic arthritis Infective myositis
102
How does septic arthritis present?
``` Limping Pseudoparalysis Swollen, red joint Refusal to move joint Pain Temperature ```
103
Where does septic arthritis usually present?
Knee and hip
104
What are the investigations for septic arthritis?
``` FBC - WCC ESR - raised CRP Blood cultures - positive XR US Synovial fluid aspirate - WCC ```
105
What is the clinical presentation for septic arthritis (Kocher criteria)?
Pyrexia Non weight-bearing High WBC count Raised ESR
106
What is the criteria for septic arthritis?
Kocher criteria
107
What is the treatment for septic arthritis?
Antibiotics - IV
108
What is septic arthritic usually caused by?
Staph aureus infection
109
What are the risk factors for osteomyelitis?
Blunt trauma | Recent infection
110
What is the mean age for presentation with osteomyelitis?
6yrs
111
What are the 3 factors in pathogenesis in acute haematogenous osteomyelitis?
Vascular anatomy Cellular anatomy Trauma
112
What are the presenting features in osteomyelitis?
``` Pain Localised signs/symptoms Fever Reduced ROM Reduced weight-bearing ```
113
What are the inflammatory markers that will be raised in osteomyelitis?
WCC ESR CRP
114
What is the most common causative agent of osteomyelitis?
Staph aureus
115
What are the investigations in osteomyelitis?
``` MRI Bone scan CT Bone biopsy After: blood culture, XR, serum CRP, ESR, FBC ```
116
What is the treatment for osteomyelitis?
IV antibiotics
117
What are indications for surgery in osteomyelitis?
``` Aspiration for culture Drainage of subperiosteal abscess Drainage of joint sepsis Debridement of dead tissue Failure to improve ```
118
What are the signs/symptoms of transient synovitis?
``` Limping Slightly unwell History of viral infection Apyrexial Allow joint to be examined Low CRP, normal WCC May have joint infusion Not that unwell! ```
119
What is transient synovitis?
Inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight
120
What are features that raise concern of neoplasm (cancer)?
``` Night pain Often incidental trauma Stops doing activities Sweats and fatigue Abnormal blood results: low Hb, atypical blood film, atypical platelets ```

MSK (17 decks)

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