Paediatrics Flashcards by Kayla Halliwell

What are the big 3?

DDH
Perthes’ disease
SUFE

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What is DDH?

Development dysplasia of the hip
Structural abnormality in the hips caused by abnormal development of foetal bones during pregnancy
Risk of subluxation or dislocation

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When is DDH diagnosed?

New-born examinations
Child presenting with hip asymmetry, reduced ROM in hip or limb

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What age group is usually affected by DDH?

<2 years

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What are the risk factors for DDH?

FH
Breech presentation
Multiple pregnancy
First born
High birth weight

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What features in a neonatal examination suggest DDH?

Different leg lengths
Restricted hip abduction on one side
Significant bilateral restriction in abduction
Difference in the knee level when the hips are flexed
Clunking of the hips on special tests

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What are 2 special tests to check for DDH?

Ortolani test- tests for anterior hip dislocation
Barlow test- tests for posterior hip dislocation

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What investigations are done for suspected DDH?

Ultrasound of hips
X rays for older infants

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What is the management of DDH diagnosed before 6 months?

Pavlik harness- kept on permanently to allow the acetabulum to develop properly. Keeps the babies hips flexed and abducted

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What is the management for DDH diagnosed after 6 months?

Surgery
Hip spica cast after surgery to immobilise the hip

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What is the general rule for DDH management?

The older the child the poorer the result

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What is Perthes’ disease?

Disruption of blood flow to the femoral head causing avascular necrosis (AVN)
This affects the epiphysis of the femur

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What is the pathology of Perthes’ disease?

Disruption of blood supply
AVN
Revascularisation or neovascularisation
Remodelling

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What is the main complication of Perthes’?

Soft and deformed femoral head leading to early OA

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What is the presentation of Perthes’?

Pain in the hip or groin
Limp
Restricted hip movements
Referred pain to the knee
No history of trauma

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What age group is affected by Perthes’?

Primary school aged

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What are the investigations for Perthes?

X ray
Bloods
MRI

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What is Perthes treatment?

Bed rest
Crutches
Analgesia
Maintain hip motion
Surgery in severe cases

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What is the surgery of choice in severe Perthes?

Osteotomy

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What is SUFE?

Slipped Upper Femoral Epiphysis
Head of the femur is displaced along the growth plate

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What group is affected by SUFE?

Boys
8-15 years
Obese children
Undergoing growth spurt

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What is the typical presentation of SUFE?

Hip, groin, thigh or knee pain
Restricted hip ROM
Painful limp
Hip kept in external rotation
Restricted internal rotation

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What is the initial investigation of choice for SUFE?

Lateral Xray

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What is the management of SUFE?

Surgery to return the femoral head to the correct position

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What are the complication of SUFE?

AVN Chondrolysis Deformity Early OA Limb length discrepancy Impingement

What is the difference between bones in children vs adults?

Growth plates More cancellous bone- spongy, highly vascular More flexible but less strong

What is the difference between fractures in children vs adults?

Heal quicky- metabolic, cellular, vascular High capacity for remodelling

What are the types of paediatric fractures?

Buckle (torus) Transverse Oblique Spiral Segmental Salter-Harris (growth plate) Comminuted Greenstick Plastic deformity

What is greenstick fracture?

Only one side of the bone breaks whilst the other side stays intact

What is buckle fracture?

Longitudinal compression

What is plastic deformity?

Sequence of small cracks in the bone

How are growth plate fractures graded?

Salter-Harris classification

What are the types of Salter-Harris fractures?

1- Straight across 2- Above 3- Below 4- Through 5- Crush

Which SH is most common?

SH2- ascends into metaphysis

What are the principles of fracture management?

1. Mechanical alignment- closed reduction or open reduction (via surgery) 2. Stability- casts, wires, braces, screws, splints

What is the fracture pain management?

1. paracetamol and ibuprofen 2. morphine

What painkillers are contraindicated in children?

Codeine Tramadol Aspirin

What causes joint pain in 0-4 years?

Septic arthritis Transient synovitis DDH

What causes joint pain in 5-10 years?

Septic arthritis Transient synovitis Perthes' disease

What causes joint pain in 10-16 years?

Septic arthritis SUFE Juvenile idiopathic arthritis

What are red flags for hip pain?

<3 Fever Waking at night with pain Weight loss Anorexia Night sweats Fatigue Persistent pain Morning stiffness Swollen or red joint

What is the most common cause of hip pain in 3-10 years?

Transient synovitis (irritable hip)

What is the presentation of transient synovitis?

Limp Refusal to weight bear Groin or hip pain Not that unwell Apyrexial

What is the management of transient synovitis?

Simple analgesia Safety net if they develop fever

What does joint pain AND a fever suggest?

Septic arthritis

What is rickets?

Osteomalacia in children- defective bone mineralisation

What causes rickets?

Vitamin D or calcium deficiency

What is the presentation of rickets?

Lethargy Bone pain Swollen wrists Bone deformity Poor growth Dental problems Muscle weakness Pathological or abnormal fractures

What is the labaratory investigation for rickets?

Serum 25- hydroxyvitamin D (<25nmol/L is diagnostic)

What is required for rickets diagnosis?

X ray (osteopenia)

What other investigations are used for rickets?

Serum calcium low Serum phosphate low Serum ALP high PTH high

What is rickets management?

Prevention- vitamin D supplements for breastfed babies Treat rickets with vit D and calcium supplements

What are some normal orthopaedic variants?

In toed gaits Bow legs Flat feet Curly toes Late walkers

What is varus bow legs?

Ankles closer together than knee <2 years

What is valgus bow legs?

Knees closer together than ankle2-7 years

What is the mean age to start walking?

12 months 50% of children walk later

Name some manufacturing defects?

Spina bifida Proximal femoral focal deficiency Thrombocytopenia absent radius (TAR syndrome) Congenital scoliosis

Name some packaging defects?

Metatarsus Adductus Infantile postural scoliosis Plagiocephaly Congenital torticollis

What is cerebral palsy?

A permanent and non-progressive motor disorder due to brain damage before birth or during first 2 years of life

What are the prenatal causes of cerebral palsy?

Placenta insufficiency Toxaemia Smoking, alcohol, drugs Infection

What are the perinatal causes of cerebral palsy?

Prematurity Anoxic injuries Infections Haemolytic diseases

What are the postnatal causes of cerebral palsy?

CMV, rubella infection Head trauma

What is the physiological classification of cerebral palsy?

Spastic Athetoid Ataxia Mixed

What is the anatomical classification of cerebral palsy?

Monoplegia Hemiplegia Diplegia Quadriplegia

What is Juvenile Idiopathic Arthritis? (JIA)

Autoimmune inflammation occurring in the joints

What are the subtypes of JIA?

Oligoarticular (pauciarticular) Polyarticular Systemic Enthesitis related Psoriatic

What is oligoarticular JIA?

4 joints or less Affects larger joints Associated with anterior uveitis No systemic symptoms

What is anterior uveitis significantly related to?

ANA positivity Causes potential blindness

What is polyarticular JIA?

5+ joints Symmetrical, small and large joints Mild systemic symptoms

Which RIA is the equivalent of adult RA in children?

Polyarticular JIA Most children are seronegative

What is systemic JIA?

Extraarticular features define the disease Fever is characteristic- rises daily then normal in morning

What are the features of systemic JIA?

Subtle salmon pink rash High swinging fevers Enlarged lymph nodes Weight loss Joint inflammation and pain Splenomegaly Muscle pain Pleuritis and pericarditis

What is enthesitis related JIA?

Child version of the seronegative spondyloarthropathies HLA B27 gene Associated with anterior uveitis Tender to localised palpation of the entheses

What is juvenile psoriatic arthritis?

Seronegative inflammatory arthritis associated with psoriasis

What are the features of psoriatic JIA?

Psoriasis plaques Nail pitting Onchylosis Dactylitis Enthesitis

What is the management of JIA?

Analgesia NSAIDs- ibuprofen Steroids DMARDs- methotrexate, sulfalazine Biologics- infliximab