Paediatric Orthopedics Flashcards
How should children with an acute limp under 3 years old be managed?
All children with an acute limp < 3 years of age should be urgently assessed in secondary care because they are at higher risk of septic arthritis and child maltreatment. Transient synovitis is rare in this age-group and the diagnosis should be made with extreme caution after excluding serious causes of limp.
What is developmental dysplasia of the hip?
Developmental dysplasia of the hip (DDH) is gradually replacing the old term ‘congenital dislocation of the hip’ (CDH). It affects around 1-3% of new-borns. DDH is slightly more common in the left hip. Around 20% of cases are bilateral.
What are the risk factors for developmental dysplasia of the hip?
Female sex: 6 times greater risk Breech presentation Positive family history Firstborn children Oligohydramnios Birth weight > 5 kg Congenital calcaneo valgus foot deformity
What tests should you perform on all children in the newborn baby check for DDH
Barlow test: attempts to dislocate an articulated femoral head
Ortolani test: attempts to relocate a dislocated femoral head
Symmetry of the leg lengths, level of the knees when hips and knees are bilaterally flexed
How is suspected developmental dysplasia of the hip confirmed?
Ultrasound is used to confirm the diagnosis if clinically suspected
If >4.5 months then X-ray is first line
How is developmental dysplasia of the hip managed?
Most unstable hips will spontaneously stabilise by 3-6 weeks of age.
Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
Older children may require surgery
Who gets screening by USS for DDH?
All breech presentations are given a 6-week USS
First degree family history of hip problems in early life
Multiple pregnancy
What is Perthes’ disease?
Degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head, specifically the femoral epiphysis. Impaired blood supply to the femoral head causes bone infarction.
What is the main risk factor for Perthes’ disease?
Perthes’ disease is 5 times more common in boys.
How does Perthes’ disease present?
Around 10% of cases are bilateral
Typically between the ages of 4-8
Hip pain that develops progressively over a few weeks
Limp
Stiffness and reduced range of hip movement
How should suspected perthes’ disease be investigated?
Diagnostic X-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
Technetium bone scan or magnetic resonance imaging if normal x-ray and symptoms persist
What complications can occur from perthes’ disease?
Osteoarthritis and premature fusion of the growth plates
What staging is used for perthes’ disease
Catterall staging
Stage 1 Clinical and histological features only
Stage 2 Sclerosis with or without cystic changes and preservation of the articular surface
Stage 3 Loss of structural integrity of the femoral head
Stage 4 Loss of acetabular integrity
How is Perthes’ disease managed?
To keep the femoral head within the acetabulum: cast, braces
If less than 6 years: observation
Older: surgical management with moderate results
Operate on severe deformities
Most cases will resolve with conservative management. Early diagnosis improves outcomes.
What are the clinical features of septic arthritis?
Hot Swollen joint with a systemically unwell child.
Kocher criteria Fever > 38.5 Non weight bearing Raised ESR Raised WCC
What organisms typically cause septic arthritis?
Note in young adults it could be Neisseria gonorrhoea. Generally, most common organism with Staph Aureus.
How should suspected Septic arthritis be investigated?
Synovial fluid aspiration
X-ray
Sepsis 6 if septic
