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Paediatrics > Paediatric Orthopaedics > Flashcards

Paediatric Orthopaedics Flashcards

1
Q

2 normal variants most commonly referred

A

Intoeing

Flat feet

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2
Q

3 variations in normal development

A

Flat feet
Femoral anteversion
Bow legs

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3
Q

4 self-correcting pathologies in childrens bones

A

Metatarsal adduction
Persistent femoral anteversion
Posterior tibial bowing
Curly toes

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4
Q

David Jones 5 S’s for assessing

A 
Symmetry
Symptomatic
Systemic illness
Skeletal disease
Stiffness

Rotational alignment- axial
Angular alignment- coronal

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5
Q

What effect does excessive femoral anterversion have on rotation of the hip?

A

Internal rotation
Leads to intoeing
Correctable pathology

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6
Q

Position of knee cap if intoeing is arising from the hip?

A

Inwards

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7
Q

Why might tibial torsion occur and what form is normal?

A

Internal torsion normal to extent

Occurs due to in utero moulding and tibial shape

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8
Q

3 variations relating to anhular alignment

A

Bowed legs
Knock knees
Flat feet

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9
Q

3 assessments for angular alignment

A

Heel raise and Jack’s test
Foot rotational alignment
Foot progression in gait

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10
Q

4 points of clinical assessment

A

Walking
Standing
Tip toe
Staheli rotational profile

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11
Q

3 points to assess in standing

A

Alignment from the front
Patellar position
Heels/arch/toe/leg length from behind

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12
Q

Staheli rotational profile

A

Hip rotation/version
Thigh foot angle
Foot bisector line

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13
Q

What is a limp?

A

Abnormal gait due to pain, weakness or derformity

Shorter stance phases (weight bearing) on affected limb

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14
Q

Common causes of limp

A 
Toxic synovitis
Septic arthritis
Trauma - teens
Osteomyelitis
Viral syndrome
Perthe's disease
Fracture
Soft tissue infection
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15
Q

What is associated with antalgic gait on examination?

A

Tenderness (shortened stance phase)

Reduced range of motion

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16
Q

Conditions causing antalgic gait

A 
Infection
Inflammation
Trauma
Overuse syndrome
Toddlers fracture
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17
Q

Which sign indicates Abductor lurch

A

Trendelendburg sign

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18
Q

What conditions are associated with abductor lurch?

A

Cerebral palsy

Hip dysplasia

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19
Q

Describe an equinus gait

A

Toe to heel gait

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20
Q

What conditions are associated with equinus gait?

A

Cerebral palsy
Idiopathic toe walker
Club foot

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21
Q

Circumduction is seen during which phase in a circumduction gait?

A

During swing phase

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22
Q

Which 3 things should be examined for if a patient has a circumduction gait?

A

Assess limb length
Neurological exam
Check range of mption

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23
Q

Which conditions are associated with a circumduction gait?

A

Painful foot

Leg length inequality

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24
Q

Which investigation can be ordered if a patient has an antalgic gait?

A

Radiograph

Bone scan

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25
Q

Which investigation should be ordered if a patient has an abductor lurch?

A

Pelvic radiograph

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26
Q

Slipped capital femoral epiphysis is most commonly seen in which patients?

A

Obese male adolescent

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27
Q

Slipped capital femoral epiphysis is likened to which object?

A

Ice cream falling off the cone

Displaced femoral head

28
Q

Why is the femoral head displaced in slipped capital femoral epiphysis?

A

Disruption of growth plate

29
Q

Symptom of slipped capital femoral epiphysis?

A

Painful limp

Referred pain to thigh or knee

30
Q

Treatment for slipped capital femoral epiphysis

A

Percutaneous screw fixation

31
Q

Differentials for infectious and inflammatory causes of limp

A

Osteomyelitis
Transient synovitis
Septic arthritis

32
Q

History for infectious causes of limp

A 
Limp
Pain
General malaise/loss of appetite/listless
Temperature
Recent URTI/ ear infection
Trauma
Pseudoparalysis
33
Q

Initial investigations acute limping child

A

Temperature
X ray
USS
Bloods - CRP, ESR, FBC, WCC, CK, cultures

34
Q

Signs and symptoms of septic arthritis

A 
Limp
Psuedoparalysis
Swollen red joint
Refusal to weight bear/ move joint
Pain
Temperature
35
Q

Routes of infection leading to septic arthritis

A 
Puncture or trauma
Dissemination from osteomyelitis
Haematogenous route
Adjacent soft tissue infection
Diagnostic or therapeutic procedures
36
Q

Investigations for septic arthritis

A 
Full Blood Count
White cell count
ESR
CRP
X ray
Ultrasound
Synovial fluid - WCC, gram stain, culture
37
Q

Clinical Predictive Criteria for Septic arthritis

A

Kocher

  1. Pyrexia
  2. Not weight bearing
  3. WBC > 12000/ml
  4. ESR >40 mm/hr

Score 3-4 indicative - 90% chance septic arthritis

38
Q

Treatment for septic arthritis

A

Antibiotics - IV 2 weeks
Aspiration
Arthroscopy
Arthrotomy

39
Q

Common infection in septic arthritis

A

Staphylococcus aureus

40
Q

Risk factors for osteomyelitis

A

Blunt trauma

Recent infection

41
Q

Mean age for osteomyeltiis in chidren

42
Q

Symptoms for osteomyelitis

A 
Pain
Reduced Range of Movement
Fever
Localised signs
Reduced weight bearing
43
Q

Investigations for osteomyelitis

A

WCC
CRP
ESR
Microbiology - staph aureus

44
Q

Indications for surgey in osteomyelitis

A 
Aspiration needed for culture
Drainage of subperiosteal abscess
Drainage of joint sepsis
Debridement of dead tissue
Failure to improve
Biopsy
45
Q

How to differentiate transient synovitis from osteomyelitis or septic arthritis?

A 
Diagnosis of exclusion
Child will allow joint to be examined
Relatively not as unwell
Recent infection
Low CRP, normal WCC
46
Q

Red flag symptoms in paediatric orthopaedics

A 
Night pain
Stops doing sport/going out
Sweats and fatigue
Abnormal bloods - low Hb, atypical film, atypical platelets
Refer to paediatrics and oncology
47
Q

Classification for fractures with physeal injury in forearm

A 
Salter Harris
Type 1 - same level
Type 2 - Above physeal plate
Type 3- Below
Type 4 Through
Type 5 Crush

SALTR - 12345`

48
Q

Describe a Galeazzi fracture

A

Shaft fracture of forearm

Distal 1/3 of radius with dislocation of radioulnar joint

49
Q

Describe a Monteggia fracture

A

Shaft of ulna

Dislocation of radial head

50
Q

What percentage of paediatric fractures occur in the forearm?

51
Q

Which fractures are most common in the forearm?

A

80% occur distally

5% pproximal to elbow

52
Q

What type of impact results in a buckle fracture?

A

Low energy

53
Q

High energy fractures can lead to what type of injury?

A

Open fracture

Soft tissue displacement

54
Q

Complications of Fractures

A 
Compartment syndrome - Volkmann's
Non union
Refracture
Radioulnar synostosis
PIN injury
Superficial radial nerve injury
Distal radioulnar joint/ Radiocapitellar problems
55
Q

Management of buckle fracture in distal radis

A

Cast 3-4 weeks

56
Q

Management of greenstick fracture in distal radius

A

Cast 3-4 weeks

57
Q

Complete fracture of distal radius management

A

Cast with Kirschner wires 6 weeks

58
Q

Risk for manipulation

A

Complete fracture
Failed anatomic reduction
Not B/E pop

59
Q

Knee trauma differential

A 
Infection
Inflammation
Neoplasm
Apophysisits
Foot
Hip
Sickle cell, haemophilia
Anterior knee pain
60
Q

Bony injury of the knee

A 
Physeal/metaphyseal
Tibial spine
Tibial tubercle
Patellar fracture
Sleeve fracture
Paterllar dislocation
Referred
61
Q

Ratio of femoral to tibial physeal injury

62
Q

Treatment for physeal knee injury

A

Cast to immobilise
Percutaneous screw fixation
ORIF articular displacement
Range of movement wihtin 6 weeks

63
Q

Elements of physeal arrest

A 
Monitor harris lines, angulation and length
Resect bar
Complete epiphysiodesis
Contralateral epiphysiodesis
Corrective osteotomy
64
Q

Why are patellar fractures rare?

A

Cartilaginous until age 4

65
Q

Management for patellar fracture

A

Undisplaced - cylinder cast

Displaced - Orif

66
Q

Risk factors for patellar dislocation

A 
Laxity
Poor VMO
Q angle
Femoral anteversion
Tibial external rotation
Patella alta
67
Q

Overuse injuries

A

Osgood Schlatters - prominent patella

Sever’s - inflammation of calcaneus

Paediatrics (10 decks)

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