Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Paediatric Orthopaedics (inc Limping Child) > Flashcards

Paediatric Orthopaedics (inc Limping Child) Flashcards

1
Q

What are paediatric specific fracture types and why do they occur?

A

Thicker, more active periosteum results in:

    1. Greenstick
    1. Buckle
    1. Plastic / Bowing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why do intraarticular fractures have worse consequences in children?

A

Usually involve the growth plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the ossification centres of the elbow?

A

CRITOE

  • Capitellum: 1y
  • Radial head: 4y
  • Internal (med) epicondyle: 6y
  • Trochlea: 8y
  • Olecranon: 10y
  • External (lat) epicondyle: 12y
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is SUFE?

A

Type I Salter Harris epiphyseal injury at proximal hip. Most common adolescent hip disorder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the RFx for SUFE?

A

Male, obese, hypothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the Hx of SUFE?

A
  • Acute: sudden, severe pain with limp

- Chronic: limp with medial knee or anterior thigh pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the PEx features of SUFE?

A
  • +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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Whitman’s sign?

A

With flexion there is obligate external rotation of the hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Aetiology SUFE?

A
  • Cartilaginous physis thickens rapidly with GH
  • Sex hormone secretion (stabilises physis) not yet commenced
  • Overweight = mechanical stress
  • Trauma = acute slip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ix SUFE?

A

-XR: frog leg, AP, lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

XR findings in SUFE?

A
  • posterior and medial slip

- disruption of Klein’s line (line on superolateral border of femoral neck should cross some femoral epiphysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rx SUFE?

A

Mild/mod: stabilise physics with pins

Severe: ORIF or pin without reduction and osteotomy after epiphyseal fusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the complications of SUFE / Mx?

A
  • AVN
  • Chondrolysis (loss of articular cartilage = joint space narrowing)
  • Pin penetration
  • Premature OA
  • Loss of ROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Legg-Calve-Perthes Disease?

A

Self limited AVN of femoral head usually presenting at 4-10y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pethes disease associations?

A
  • FHx
  • Low birth weight
  • Abnormal pregnancy / delivery
  • Hx of trauma to affected hip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the key features of Perthes disease?

A
  • AVN of proximal femoral epiphysis
  • Abnormal growth of the physis
  • Eventual remodelling of regenerated bone
17
Q

CFx of Pethes disease?

A
  • Child with hip pain and limp
  • Tender over anterior thigh
  • Flexion contracture (decreased IR and abduction of hip)
18
Q

Goal of Rx of Perthes?

A

Preserve ROM and femoral head in acetabulum

19
Q

What are the KEY diagnoses for a child with limp by age?

A
  • Under 2: DDH
  • 3 - 5y: Transient synovitis
  • 5 - 9y: Perthes
  • 11-16: SUFE
20
Q

What are the red flags for organic causes of a limp / leg pain?

A

• 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

21
Q

What are the indicators of a non organic cause for pain / limp?

A

• 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

22
Q

Mx of Perthes?

A
  • Physio for ROM
  • Anti inflammatories
    Containment:
  • Bracing in abduction
  • Femoral osteotomy
  • Pelvic osteotomy
23
Q

What are congenital talipes?

A

Club foot. 3 parts:

  • talipes: talus invertedand internally rotated
  • equinus: ankle plantar flexed
  • varus: heel and forefoot are in varus
24
Q

Aetiology of congenital talipes?

A
  • Intrinsic: neuro, muscular or CT diseases

- Extrinisc: IUGR

25
Q

What causes Osgood-Schlatter disease?

A

Repetitive tensile stress on insertion of patellar tendon over the tibial tuberosity causing minor avulsion at the site and thus inflammatory reaction (tibial tubercle apophysitis)

26
Q

FX of OS disease?

A
  • Tender lump over tibial tuberosity
  • Pain on resisted leg extension
  • anterior knee pain exacerbated by jumping or kneeling, relieved by rest
27
Q

Rx OS disease?

A
  • benign, self limited
  • may restrict activities
  • flexibility, isometric strengthening exercises
28
Q

What must always be excluded in a non weight bearing child?

A
  • osteomyelitis
  • septic arthritis
  • malignancy
29
Q

Mx limping child with no specific cause?

A

Depends on diagnosis. If no specific cause identified, or suscpected transient synovititis:
• Bed rest important (esp TS)
• Analgesia: NSAID (ibuprofen) +/- paracetamol
• Review with LMO 3d
• Return to hospital if febrile, unwell or getting worse
Pts with symptoms >4w ==> referr to rheum clinic

30
Q

When should ortho / paeds be consulted in NWB child?

A
  • suspect infection, Perthes, SUFE or malignancy
  • multiple presentations
  • uncertain
31
Q

Hx approach to limping child?

A 
Pain = SQSTCARA
CONTEXT: trauma, preceding illness
AFx: 
- fever
- morning stiffness
- S/R
- systemic symptoms (infective or inflammatory cause)
PLUS:
- previous injuries or CP notifications
32
Q

What is a Monteggia fracture?

A

Fracture of proximal third of Ulna with dislocation of radial head

33
Q

Mechanism of supracondylar fracture?

A

FOOSH

34
Q

Which artery may be injured in supracondylar fracture?

A

Brachial artery

35
Q

Which nerves at potential risk of injury in supracondylar fracture?

A
  • median
  • radial
  • ulnar
36
Q

XR to order in ?supra condylar fracture?

A
  • True lateral of elbow

- AP and lat views of forearm

37
Q

Classification system of supracondylar fractures?

A

Gartland (I-III)

Paediatrics (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions