Paediatric Orthopaedics (inc Limping Child) Flashcards
What are paediatric specific fracture types and why do they occur?
Thicker, more active periosteum results in:
- Greenstick
- Buckle
- Plastic / Bowing
Why do intraarticular fractures have worse consequences in children?
Usually involve the growth plate
What are the ossification centres of the elbow?
CRITOE
- Capitellum: 1y
- Radial head: 4y
- Internal (med) epicondyle: 6y
- Trochlea: 8y
- Olecranon: 10y
- External (lat) epicondyle: 12y
What is SUFE?
Type I Salter Harris epiphyseal injury at proximal hip. Most common adolescent hip disorder.
What are the RFx for SUFE?
Male, obese, hypothyroid
What are the Hx of SUFE?
- Acute: sudden, severe pain with limp
- Chronic: limp with medial knee or anterior thigh pain.
What are the PEx features of SUFE?
- +ve Trendelenburg on affected side due to glut weakening
- Tender over joint capsule
- Restricted IR, abduction, flexion, Whitman’s sign
- Pain at extremes of ROM
What is Whitman’s sign?
With flexion there is obligate external rotation of the hip
Aetiology SUFE?
- Cartilaginous physis thickens rapidly with GH
- Sex hormone secretion (stabilises physis) not yet commenced
- Overweight = mechanical stress
- Trauma = acute slip
Ix SUFE?
-XR: frog leg, AP, lateral
XR findings in SUFE?
- posterior and medial slip
- disruption of Klein’s line (line on superolateral border of femoral neck should cross some femoral epiphysis)
Rx SUFE?
Mild/mod: stabilise physics with pins
Severe: ORIF or pin without reduction and osteotomy after epiphyseal fusion
What are the complications of SUFE / Mx?
- AVN
- Chondrolysis (loss of articular cartilage = joint space narrowing)
- Pin penetration
- Premature OA
- Loss of ROM
What is Legg-Calve-Perthes Disease?
Self limited AVN of femoral head usually presenting at 4-10y
Pethes disease associations?
- FHx
- Low birth weight
- Abnormal pregnancy / delivery
- Hx of trauma to affected hip
What are the key features of Perthes disease?
- AVN of proximal femoral epiphysis
- Abnormal growth of the physis
- Eventual remodelling of regenerated bone
CFx of Pethes disease?
- Child with hip pain and limp
- Tender over anterior thigh
- Flexion contracture (decreased IR and abduction of hip)
Goal of Rx of Perthes?
Preserve ROM and femoral head in acetabulum
What are the KEY diagnoses for a child with limp by age?
- Under 2: DDH
- 3 - 5y: Transient synovitis
- 5 - 9y: Perthes
- 11-16: SUFE
What are the red flags for organic causes of a limp / leg pain?
• Pain on passive internal rotation
• Pain during both night and day
• Pain occurs on weekends and vacations i.e. true pain
• Pain interrupts play and other pleasant activities
• Pain localised to joint *
• Unilateral pain * cf. growing pain is bilateral
• Child limps or refuses to walk
• Pain fits with local anatomic explanation
• Concurrent symptoms and signs of systemic disease
Acute onset in last 3 months
What are the indicators of a non organic cause for pain / limp?
• No pain on passive internal rotation
• Pain occurs only at night and on school days
• Pain does not interfere with normal activities
• Pain located between joints
• Bilateral symptoms
• Child is able to walk normally without a limp
• Pain patter does not fit any recognizable anatomy
Systemic signs and sypmtoms absent
Mx of Perthes?
- Physio for ROM
- Anti inflammatories
Containment: - Bracing in abduction
- Femoral osteotomy
- Pelvic osteotomy
What are congenital talipes?
Club foot. 3 parts:
- talipes: talus invertedand internally rotated
- equinus: ankle plantar flexed
- varus: heel and forefoot are in varus
Aetiology of congenital talipes?
- Intrinsic: neuro, muscular or CT diseases
- Extrinisc: IUGR
