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MSK > Paediatric orthopaedics > Flashcards

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
Q

What are differentials for bilateral Perthes disease?

A

Hypothyroid
Sickle
Epiphyseal dysplasia

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26
Q

What is the treatment for Perthes disease?

A

Maintain hip motion/restore ROM
Analgesia: NSAIDs
Traction, crutches, physio
Osteotomy sometimes in older patients with severe disease

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27
Q

What are the investigations for Perthes disease?

A

XR
Bone scan
MRI
Bloods - will be normal

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28
Q

What is SCFE?

A

Slipped capital femoral epiphysis = the head of the femur ‘slips’ out of alignment due to shearing forces across the growth plate

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29
Q

What sex does SCFE affect more?

A

Males

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30
Q

What are the classifications of SCFE?

A

Acute vs chronic

Stable vs unstable

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31
Q

When is SCFE chronic?

A

3wks

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32
Q

What are the signs/symptoms of SCFE?

A

Pain in hip or knee
Externally rotated posture & gait
Reduced internal rotation, especially in flexion
Antalgic gait

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33
Q

What are the investigations for SCFE?

A

XR - lateral view

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34
Q

What are the risk factors for SCFE?

A

Obesity/high BMI (strain on growing femur)
Trauma
Male
Endocrine disorders

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35
Q

What is the management of SCFE?

A

Surgery

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36
Q

What is the pathology of SCFE?

A

Capital femoral physis is displaced from the metaphysis

Due to mechanical forces on a susceptical physis

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37
Q

What are complications of SCFE?

A

AVN
Chrondrolysis
Deformity
Early OA

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38
Q

What type of SCFE has a higher risk of AVN?

A

Unstable slips - unable to bear weight

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39
Q

What line is broken in a dislocated hip?

A

Shenton line

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40
Q

At what age are knock knees normal?

A

2-7yrs

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41
Q

At what age is bow leg common?

A

<2yrs

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42
Q

At what age is symmetrical physiological varus legs normal?

A

<18mo

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43
Q

At what age is symmetrical physiological valgus legs normal?

A

18m-7yrs

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44
Q

What is the mean walking age?

A

12mo

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45
Q

What are causes for intoeing and tripping?

A

Femoral anteversion
Int. tibial torsion
Metatarsus adductus

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46
Q

Is femoral anteversion normal?

A

Developmental norm

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47
Q

What is internal tibial torsion?

A

Increased thigh foot angle

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48
Q

What is the treatment for internal tibial torsion?

A

90% resolve sponatneously
Splints
Wedges
Insoles

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49
Q

Are flexible flat feet normal at birth?

A

Yes

50
Q

What is the normal prognosis for flexible flat feet?

A

Diminishes with age

Asymptomatic

51
Q

Are curly toes normal?

A

Yes

52
Q

What are ways of performing gait analysis?

A

Observational
Video equipment
3D instrumented

53
Q

What is normal gait?

A

Series of rhythmical, alternating movements of the trunk and limbs which result in forward progression of centre of gravity

54
Q

When does the gait cycle begin?

A

When reference foot contacts the ground

55
Q

When does the gait cycle end?

A

Subsequent floor contact of the same foot

56
Q

What is step length?

A

Distance between corresponding successive points of heel contact of the opposite feet

57
Q

What is stride length?

A

Distance between successive points of heel contact of the same foot

58
Q

How do the step length and stride length compare in normal gait?

A

Stride length is double step length

59
Q

What is the walking base?

A

Side-to-side distance between the line of the two feet

60
Q

What is cadence?

A

No steps per unit time

61
Q

What is normal cadence?

A

100-115 steps/min

62
Q

What are the two phases of the gait cycle?

A

1) Stance phase

2) Swing phase

63
Q

What are the components of the stance phase of the gait cycle?

A

1) Heel contact
2) Foot-flat
3) Midstance
4) Heel-off
5) Toe-off

64
Q

What are the components of the swing phase of the gait cycle?

A

1) Acceleration
2) Midswing
3) Deceleration

65
Q

Which phase of the gait cycle is usually longer?

A

Stance phase

66
Q

Where is centre of gravity typically?

A

Midway between hips, few cm infront of S2

67
Q

What are the forces that have the most influence on gait due to?

A

Gravity
Muscular contraction
Inertia
Floor reaction

68
Q

What are common gait abnormalities?

A 
Antalgic gait
Lateral trunk tilt - Trendelenburg
Function leg-length discrepancy
Increased walking base
Inadequate dorsiflexion control
Excessive knee extension
69
Q

What happens in antalgic gait?

A

Stance phase on affected side is shortened
Increase in stance phase on unaffected side
Common: OA, tendinitis

70
Q

What side is lateral trunk tilt/Trendelenberg gait usually?

A

Usually unilateral

Bilateral = waddling gait

71
Q

What are common causes of Trendeleberg gait?

A

Painful hip
Hip abductor weakness
Leg-length discrepancy
Abnormal hip joint

72
Q

What are 4 common compensations for functional leg-length discrepancy?

A

Circumduction
Hip hiking
Steppage
Vaulting

73
Q

What are common causes of increased walking base?

A

Deformities: abducted hip, valgus knee
Instability: cerebellar ataxia, proprioception deficits

74
Q

What happens in inadequate dorsiflexion control?

A

In stance phase: foot slap

In swing phase: toe drag

75
Q

What are causes of inadequate dorsiflexion control?

A

Weak tibialis anterior

Spastic plantarflexors

76
Q

What happens in excessive knee extension?

A

Loss of normal knee flexion during stance phase

Knee may go into hyperextension

77
Q

What are common causes of excessive knee extension?

A

Quadriceps weakness/spasticity

Knee flexor weakness

78
Q

What are the 5S’s for joints?

A 
Symptoms 
Symmetry
Stiffness
Syndromes
Systemic illness
79
Q

If there is knee pain what else should you think about?

A

Hips

80
Q

If there is night pain what should you consider?

A

Infection or tumour

81
Q

What is the commonest cause of death in children?

A

Trauma

82
Q

What are the fracture principle’s for management in children?

A

Fixation not usually required
Do not over immobilise
Do not over treat

83
Q

What is it important to know in fractures involving physes?

A

Can result in progressive deformity

84
Q

What is a Galeazzi fracture?

A

Fracture of distal third of the radius with dislocation of the distal radioulnar joint

85
Q

What is a Monteggia fracture?

A

Fracture of the distal third of the ulnawith dislocation of the proximal head of the radius

86
Q

What % of paeds fractures are forearm?

A

25-50%

87
Q

Where are more of the fractures of the forearm in paeds?

A

Distal radial fractures

88
Q

How many degrees can you normally supinate?

A

85’

89
Q

How many degrees can you normally pronate?

A

75’

90
Q

What are the options for treatment of paeds fractures?

A

Open vs closed treated

91
Q

What are indications for surgery?

A

Open fracture
Segmental
NV compromise
Failed closed Rx

92
Q

What is ORIF?

A

Open reduction internal fixation

93
Q

What are complications of fracture management?

A 
Compartment syndrome
Nonunion
Refracture
Radioulnar synostosis
PIN injury
Superficial radial nerve injury
DRUJ/radiocapitellar problems
94
Q

What is a distal radius buckle (torus) fracture?

A

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
Q

What is a greenstick fracture?

A

A fracture in a young, soft bone in which the bone bends and breaks

96
Q

What is the management of buckle, greenstick and complete fractures?

A

Cast

97
Q

What is the risk for remanipulation of fractures?

A

Complete fractures

Failed anatomic reduction

98
Q

What are the differentials for knee trauma?

A 
Infection
Inflammatory arthropathy
Neoplasm
Apophysitis
Hip/foot
Sickle
Haemophilia
99
Q

What are types of bony injury of the knee?

A 
Physeal/metaphyseal
Tibial spine
Tibial tubercle
Patellar fracture
Sleeve fracture
Patellar dislocation
Referred
100
Q

What are paediatric overuse injuries?

A

Osgood-Schlatter’s disease

Sever’s disease

101
Q

What are differentials for the acute limping child?

A

Transient synovitis
Osteomyelitis
Septic arthritis
Infective myositis

102
Q

How does septic arthritis present?

A 
Limping
Pseudoparalysis
Swollen, red joint
Refusal to move joint
Pain
Temperature
103
Q

Where does septic arthritis usually present?

A

Knee and hip

104
Q

What are the investigations for septic arthritis?

A 
FBC - WCC
ESR - raised
CRP
Blood cultures - positive
XR
US
Synovial fluid aspirate - WCC
105
Q

What is the clinical presentation for septic arthritis (Kocher criteria)?

A

Pyrexia
Non weight-bearing
High WBC count
Raised ESR

106
Q

What is the criteria for septic arthritis?

A

Kocher criteria

107
Q

What is the treatment for septic arthritis?

A

Antibiotics - IV

108
Q

What is septic arthritic usually caused by?

A

Staph aureus infection

109
Q

What are the risk factors for osteomyelitis?

A

Blunt trauma

Recent infection

110
Q

What is the mean age for presentation with osteomyelitis?

A

6yrs

111
Q

What are the 3 factors in pathogenesis in acute haematogenous osteomyelitis?

A

Vascular anatomy
Cellular anatomy
Trauma

112
Q

What are the presenting features in osteomyelitis?

A 
Pain
Localised signs/symptoms
Fever
Reduced ROM
Reduced weight-bearing
113
Q

What are the inflammatory markers that will be raised in osteomyelitis?

A

WCC
ESR
CRP

114
Q

What is the most common causative agent of osteomyelitis?

A

Staph aureus

115
Q

What are the investigations in osteomyelitis?

A 
MRI
Bone scan
CT
Bone biopsy
After: blood culture, XR, serum CRP, ESR, FBC
116
Q

What is the treatment for osteomyelitis?

A

IV antibiotics

117
Q

What are indications for surgery in osteomyelitis?

A 
Aspiration for culture
Drainage of subperiosteal abscess
Drainage of joint sepsis
Debridement of dead tissue
Failure to improve
118
Q

What are the signs/symptoms of transient synovitis?

A 
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
Q

What is transient synovitis?

A

Inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight

120
Q

What are features that raise concern of neoplasm (cancer)?

A 
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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