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MDD > Paediatric Orthopaedics > Flashcards

Paediatric Orthopaedics Flashcards

1
Q

what is developmental dysplasia of the hip

A

spectrum of disorders ranging from subluxation to dysplasia

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2
Q

why is early identification of developmental dysplasia important

A

because it responds to conservative treatment early on but requires surgery if you leave it

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3
Q

how is developmental dysplasia of the hip screened for

A

ortolanis and barlows procedure in the newborn examination

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4
Q

if missed at screening, how does developmental dysplasia of the hip usually present

A

limping, or asymmetrical skin folds

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5
Q

what is the next line investigation for ?developmental dysplasia of the hip

A

paeds referral + ultrasound of the hip

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6
Q

what is the treatment for developmental dysplasia of the hip

A

pavlick harness for several months

monitoring via several xrays/USS

surgery if insufficient response or if detected late

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7
Q

why must a pavlick harness be set up by an expert?

A

incorrect splinting may lead to avascular necrosis

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8
Q

what are the risk factors for developmental dysplasia of the hip?

A

Breech presentation

Oligohydramnios

Female sex

Family history

Firstborn

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9
Q

what is pes planus

A

flat feet (loss of medial longitudinal arch)

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10
Q

what condition is marked flat feet common in

A

hypermobility

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11
Q

when is a rigid flat food pathological

A

in older children/adolescents as young most young children grow out of it

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12
Q

what are common causes of a pathological flat foot

A

Teno-achilles ocntracture

Juvenile inflammatory arthropathy

Tarsal coalition

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13
Q

what is positional talipes

A

mild inversion deformity of the foot due to intrauterine pressure

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14
Q

how do you treat positional talipes

A

passive manipulation

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15
Q

what is talipes equinovarus

A

aka club foot

entire foot is inverted and supinated
forefood adducted and heel rotated inwards in plantar flexion

foot is shorter and calf muscle thinner than usual

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16
Q

what are causes of talipes equinovarus

A

secondary to oligohydramnios
features of malformation syndrome
features of neuromuscular disorders such as spina bifiida

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17
Q

how do you treat talipes equinovarus

A

Caster plasting and bracing

May be required for many months

Surgery required if unsuccessful

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18
Q

what is scoliosis

A

abnormal lateral curvature in the spine

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19
Q

what are the causes of scoliosis

A

most commonly idiopathic

congenital (VACTERL, spina bifida, hemivertebrae)

secondary (neuromuscular imbalance, disorders of bone, leg length discrepancy)

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20
Q

how should you investigate scoliosis

A

look at spine whilst standing up straight

if disappears when they bend over its postural

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21
Q

what is the management for scoliosis

A

mild = resolves spontaneously/progresses minimally

severe = specialist referral for bracing

surgery only indicated if there is respiratory/cardiovascular/neurological interference

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22
Q

what is torticollis

A

flexion/extension/twisting of the muscles in the neck allowing the neck to move beyond what is normal

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23
Q

what is the most common cause of torticollis in infants

A

SCM tumour

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24
Q

what are common causes of torticollis in kids

A

muscular spasm
secondary ENT infection
cervical spine arthritis
spinal tumour

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25
Q

what is the management for acute torticollis

A

Painkiller

Possibly diazepam for muscle relaxation but caution

Exercise of head and neck important to prevent neck stiffening

Heat packs and good posture

Persistence = botox

Surgery reserved for very severe cases – involves severing nerves around the face to help with relaxation

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26
Q

what are common sites of non accidental fractures in children

A

posterior ribs

long bones

complex skull fractures

usually multiple

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27
Q

what should be ruled out whne reviewing possible non accidental injury fractures

A

osteogenesis imperfectica

copper deficiency

both can cause decreased fracture thresholds

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28
Q

what is osteomyelitis

A

infection of the metaphysis (head portion) of the long bones

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29
Q

what are the most common sites for osteomyelitis

A

distal femur/proximal tibia

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30
Q

what are common causative organisms for osteomyelitis

A

S.aureus
streptococcus
Hib
Tb

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31
Q

what pathogens are at an increased risk of causing osteomyelitis if the patient has sickle cell disease

A

salmonella/staph

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32
Q

what are clinical features of osteomyelitis

A

Painful immobile limb

Acute febrile illness

Local swelling/tenderness with erythema

Pain on movement

Sterile effusion in joint space

May be more insideous In infants where limb immobilisation/swelling is the first sign

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33
Q

when do radiographic changes begin to occur in osteomyelitis

A

7-10 days

34
Q

what is the best imagine method to visualise osteomyelitis

A

MRI

35
Q

what does chronic osteomyeltitis look like on an XR

A

periosteal reaction along the shaft

multiple hypodense areas with metaphyseal regions

36
Q

how do you manage osteomyelitis

A

IV ABx for several weeks

surgical drainage if required (no rapid response to Abc)

immobilisation of the bone

37
Q

what are the complications of osteomyelitis

A

Bone necrosis

Chronic infection

Limb deformity

Amyloidosis

38
Q

how does subacute osteomyelitis present

A

insideous onset with mild symptoms over a period of months

Signs include:
Swelling 
Erythema  
Warmth 
Pain on movement of the adjacent joint  
Some joint effusion present  
Surrounding muscle wasting
39
Q

what is the average time of diagnosis from inital presentation of symptoms of subacute osteomyelitis

A

1-6 months

40
Q

what are symptoms of chronic osteomyelitis

A

Bone pain

Persistent fatigue

Pus draining from a sinus

Local swelling

Skin changes

Excessive sweating

Chills

41
Q

what are the risks of untreated osteomyelitis

A

Left untreated this can spread to other bones, causing widespread infection, sepsis or death

With chronic disease there is destruction of bone which is permanent and may result in the need for amputation due to poor vascularisation of remaining bone

42
Q

in children, what age group most commonly gets septic arthritis

A

<2 years

43
Q

what organisms most commonly cause septic arthritis

A

staph aureus

Hib

44
Q

what is the clinical presentation of septic arthritis

A

Erythematous, warm, acutely tender joint

Reduced range of movement

Unwell, febrile child

Infants cry and hold the limb

There may be joint effusion

In toddlers if the pathology is in the legs there may be a limb or referred knee pain (if hip)

45
Q

how should you investigate ?septic arthritis in a child

A

Increases WCC/CRP

Positive blood cultures

USS of deep joints identifies effusions

XR excludes bony trauma and other lesions – but usually normal apart from joint space widening and soft tissue swelling

Bone scan may be helpful

MRI excludes adjacent osteomyelitis

DEFINITIVE MEASURE
Aspiration of joint space and culture under ultrasound guidance

46
Q

what is the treatment for septic arthritis

A

Prolonged course of antibiotics – especially IV

Washing out of joint spaces/surgical drainage may be required if resolution does not occur rapidly

Immbolisation of joint in a functional position – but must be mobilised to prevent deformity

47
Q

what is perthes disease

A

Avascular necrosis of the capital femoral epiphysis of the femoral head due to the interruption of the blood supply followed be revascularisation and reossification over the next 18-36 months

48
Q

what is the common gender and age range for perthes disease

A

boys, 5-10 years old

49
Q

how does perthes disease present

A

insideous onset of limping, knee pain hip pain

50
Q

what is a common differential of perthes disease

A

transient synovitis

51
Q

what % of cases is perthes disease bilateral

A

10-20%

52
Q

how should perthes disease be investigated

A

AP, Lateral and frog legs XR

53
Q

whar radiological signs indicate perthes disease

A

increased density of the femoral head, subsequently becoming fragmented and more irregular

54
Q

what is the management for perthes disease

A

if found early and <50% of femoral head affected = bed rest and traction

more severe disease/late presentation: femoral + pelvic osteotomy with maintained hip abduction

55
Q

whats the prognosis of perthes disease

A

Mostly good, Particularly those below the age of 6 with less than half of the epiphyses involved

In older children, or in those with more extensive involvement of the epiphyses, deformity of the femoral head and metaphyseal damage is more likely, with potential for subsequent degenerative arthritis in adult life

56
Q

what is a slipped upper femoral epiphysis

A

Postero-inferio displacement of the femoral head requiring prompt treatment in order to prevent avascular necrosis

57
Q

what patient population is slipped upper femoral epiphysis most common in

A

overweight 10-15 year old boys

58
Q

what % of slipped upper femoral epiphysis cases are bilateral

A

20%

59
Q

what metabolic abnormalities is slipped upper femoral epiphysis assoicated with

A

hypogonadism

hypothyroidism

60
Q

how does slipped upper femoral epiphysis present

A

limp/hip pain
maybe referred knee pain

restricted abduction and external rotation of the hip

61
Q

how do you confirm slipped upper femoral epiphysis

A

XR

frog legs lateral should be included

62
Q

how do you manage slipped upper femoral epiphysis

A

Surgical
Pin fixation in situ
This should be based on if the condition is acute (<3 weeks) or chronic and if they can weight bear or not

Post-surgery rehab
Crutches for 6-8 weeks

Physio

Analgesia
NSAIDS

63
Q

what is transient synovitis

A

acute hip pain associated with a viral infection

64
Q

what is the most common cause of hip pain in children

A

transient synovitis

65
Q

what is the age range for transient synovitis

A

kids 2-12

66
Q

whats the presentation of transient synovitis

A

Sudden onset pain in hip

No pain at rest

Decreased range of movement
Specifically internal rotation

Afebrile or mild fever

Does not appear ill

67
Q

what is an important differential for transient synovitis

A

septic arthritis

68
Q

how do you manage transient synovitis

A

Bed rest

Traction

Usually improves within a few days

69
Q

what kind of inheritence is achondroplasia

A

autosomal dominant - 50% are new mutations

70
Q

what are clinical features of achondroplasia

A

Short stature
Marked shortening of limbs

Large head

Frontal bossing

Depression of nasal bridge

Short + broad hangs

Marked lumbar lordosis

Hydrocephalus – sometimes

71
Q

what is thanatophoric dysplasia

A

cause of still birth - infants have large head, extremely short limbs and a small chest

72
Q

how is cleidocranial disorder inherited

A

autosomal dominant

73
Q

what are the features of cleidocranial disorder

A

Absence of clavicle, delay in closure of anterior fontanelle and/or ossification of the skull

short stature

normal intelligence

patients can bring shoulders to meet in front of their body

74
Q

what is athorogryposis

A

Heterogenous group of congenital disorders in which there is stiffness and contracture of joints

75
Q

what is athorogryposis associated with

A

oligohydramnios, widespread congeintal anomalies or chromosomal disorders

76
Q

what type of deformities are common with athorogryposis

A

Marked flexion of the knees/elbows/wrists + dislocation of the hips and other joints, talipes equinovarus and scoliosis are common

skin is thin

intelligence usually unaffected

77
Q

whats the management for athorogryposis

A

physio

correction of deformities

where possible - splints/casts/surgery

78
Q

what is osteopetrosis

A

increased density of bone leading to over-deposition of calcium and brittleness

79
Q

how is osteopetrosis inherited

A

autosomal recessive

80
Q

how does osteopetrosis present

A

FTT

Recurrent infection

Hypocalcaemia

Anaemia

Thrombocytopenia

81
Q

what cures osteopetrosis

A

bone marrow transplant

MDD (22 decks)

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