Paediatrics Flashcards
how to bones grow?
longitudinally from the growth plate by enchondral ossification
circumferentially from the periosteum by appositional growth
when do the limb buds start to develop?
four weeks gestation
these are made of mesoderm, covered in ectoderm
when does the primary ossification centre form in long bones?
by week 12 gestation
how can bone age be calculated?
by doing XRs of the hand and wrist
what can cause problems with the growth plate?
trauma infection tumours radiation surgery compression
what condition can be diagnosed upon infant hip scanning?
developmental dysplasia of the hip (DDH)
who is more likely to have DDH - females or males?
females
which hip is most commonly affected by DDH?
left hip
what is DDH a risk factor for?
early onset OA
name some risk factors for DDH
breech family history oligohydramnios first born larger babies multiple pregnancy babies
when is USS done for suspected DDH?
breech
first degree family history
moulded baby
when is screening done for DDH?
neonatal check before sent home
6-8 week GP check
what can be seen on inspection in DDH?
asymmetry
loss of knee height
less abduction
what specific tests are done to screen for DDH?
barlow’s maneouvre - if dislocates = DDH
ortolani maneouvre
what is the treatment for DDH if caught early?
pavlik harness for up to 12 weeks until USS normal, followed by night time splinting for a few weeks
when can late DDH be caught?
not until the patient starts walking
how is late DDH managed?
surgery
hip will not be normal, often need further surgery
what is SUFE?
slipped upper femoral epiphyses
when the ball of the hip starts to slip off of the growth plate
what are some risk factors for SUFE?
rapid pubertal growth
over weight or under weight
how does SUFE present?
hip, groin, thigh or knee pain
antalgic gait
lower limb is short and externally rotated
if severe, can’t walk
how is SUFE diagnosed?
2 x-rays at 90 degrees to each other
what is transient synovitis and what causes it?
inflammation of the synovium
often secondary to a viral illness
how does transient synovitis present?
history of viral infection
mild limp
fever
what is perthes disease?
AVN of the hip in children
what causes perthes disease?
idiopathic
who is most commonly affected by perthes disease?
males
4-8 years old
lower socioeconomic groups
how is perthes disease managed?
conservative management
what is a possible complication after perthes disease heals?
trochanteric overgrowth
what is cerebral palsy?
a persistent motor disorrder due to non progressive damage to the brain before the CNS is complete
when does cerebral palsy present?
before the age of three
what does brain injury cause in cerebral palsy?
increased tone, abnormal posture - causing contracture of bone and bone deformity
also cause spasticity of muscles
what orthopaedic issue is there an increased risk of in patients with cerebral palsy?
dislocations
what is the GMFCS, and what does this mean for a cerebral palsy patients dislocation risk?
gross motor functional classification score
higher score = higher risk
what spinal issue is common in patients with cerebral palsy?
scoliosis
when can tip toe walking be normal?
up til age of three
what are some possible pathological causes of tiptoe walking?
cerebral palsy
PNS problems
muscular dystrophy
idiopathic
how is idiopathic tiptoe walking managed?
physio
casting
stretches
rarely surgery
which direction of curve in scoliosis is more concerning and why?
to the left
can affect the heart
