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MSK > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Describe the development of the femoral head

A

Mainly cartilage in childhood
Slowly ossifies with age
X-rays not as useful in paediatric hip assessment

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2
Q

What is developmental dysplasia of the hip

A

A disorder of abnormal development that results in dysplasia and possibly subluxation or dislocation
Instability of joint leads to dysplasia which gradually leads to dislocation

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3
Q

Which groups are most commonly affected by DDH

A

Left hips
Females
Native Americans and Laplanders

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4
Q

What is the pathophysiology of DDH

A

initial instability thought to be caused by maternal and fetal laxity, genetic laxity, and intrauterine and postnatal malpositioning

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5
Q

What are the risk factors for DDH

A

Firstborns - may be due to less intrauterine space
Females
Breech presentations
Family history
Oligohydramnios - low amniotic fluid volume

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6
Q

How does DDH present

A

Abnormality on screening - early
Limping child - short leg and trendelenberg
Decreased abduction, externally rotated leg
Pain later in life - due to arthritic changes

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7
Q

How do you diagnose DDH

A

Clinical exam - will have restricted abduction, different leg lengths
US
Radiographs in later years - AP X-ray

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8
Q

What is the Barlow test

A

Push backwards on hip joint to test if you can dislocate it

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9
Q

What is the ortolani test

A

If hip is already out of joint you abduct the hip to try and relocate

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10
Q

How can you treat DDH if it presents early

A

Pavlik harness - holds hips in position of safety
Worn 23hrs a day for up to 12 weeks
Serial USS to look for improvement

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11
Q

How can you treat DDH if it presents late

A

Surgery
Either a closed or open reduction
With tenotomy or osteotomy - cut tendon or bone

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12
Q

What is transient synovitis

A

Inflammation of the synovium
Often occurs secondary to a viral illness
Common in ages 0-5

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13
Q

How does transient synovitis present

A

History of viral illness but systemically well
Limp - antalgic
Hip/groin pain - may radiate to knee
Typically able to weight bear
Hip lies flexed and externally rotated
Pain at end range of movement - may decrease ROM

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14
Q

How do you diagnose transient synovitis

A

Blood tests
Kocher’s criteria
Ultrasound - looks for fluid in joint, may have effusion
Aspiration - rule out septic arthritis

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15
Q

What is Kocher’s criteria

A

Allows you to differentiate between transient synovitis and septic arthritis
List of clinical features - each one present increases risk of it being septic

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16
Q

How do you treat transient synovitis

A

Self-limiting condition
Rest
Analgesia or NSAIDs to cope with symptoms
If concerned offer review appointment

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17
Q

What is septic arthritis

A

Intra-articular infection of the joint

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18
Q

Why is septic arthritis (of the hip) a surgical emergency

A

High bacterial load in joint can lead to sepsis
Joint destruction due to proteolytic enzymes
Potential for necrosis

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19
Q

How does septic arthritis present in the hip

A

Short duration of symptoms
Unable to weight bear and hip/groin pain
Antalgic gait - limp
Hip lying flexed/externally rotated
Severe hip pain on passive movement - will have significantly decreased RPM
Usually pyrexial but may be haemodynamically stable
Raised WCC and CRP

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20
Q

How does septic arthritis arise

A

Direct inoculation - trauma or surgery
Hematogenous seeding - most common
Extension from adjacent bone (osteomyelitis)
Contiguous spread of osteomyelitis

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21
Q

What are some common causative organisms of septic arthritis

A

Neonates - Strep and gram -ve
Kids - staph aureus, haem influenza
Adults - staph aureus and strep
PWID - atypical

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22
Q

How do you diagnose septic arthritis

A 
Blood tests - FBC, CRP 
Blood cultures 
Kocher's criteria 
Radiographs - rules out other pathology
US +/- aspiration
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23
Q

How do you treat septic arthritis

A

Open surgical washout

Antibiotics - usually 6 weeks IV

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24
Q

What is Perthes disease

A

Avascular necrosis of the hip

Usually idiopathic

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25
Q

What are some risk factors for Perthes disease

A

positive family history
low birth weight
second hand smoke
Asian, Inuit, and Central European decent

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26
Q

Which groups most commonly get Perthes disease

A

Males - 5x more common
4-8 year olds
Low socioeconomic class

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27
Q

Describe the pathophysiology of Perthes disease

A

Disruption of blood supply to femoral head leads to osteonecrosis
Revascularisation occurs with subsequent reabsorption and collapse
Remodelling eventually occurs

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28
Q

What are some potential mechanisms of Perthes disease (e.g. how it develops)

A

May be associated with abnormal clotting factors

Repeated trauma and mechanical overload could lead to collapse and repair

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29
Q

The older you present with Perthes, the better the prognosis - true or false

A

False

Younger presentations have better prognosis

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30
Q

What are the 4 stages of Perthes disease

A

Initial
Fragmentation
Reossification
Remodelling

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31
Q

How does Perthes disease present

A

Gradual onset of painless limp
Sometimes intermittent groin or knee pain
Hip stiffness on
internal rotation and abduction - reduced ROM
Limp - short leg and trendelenberg

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32
Q

How do you diagnose Perthes

A

Radiographs - can be relatively normal in early stages
MRI
Look for flattened femoral head - progressive deformity

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33
Q

How do you treat Perthes disease

A

Aim is to keep femoral head round whilst the process self-terminates
Restrict weight bearing and rest the joint
Physio to maintain range of movement
Surgery (osteotomy) for people with severe deformity

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34
Q

What is SUFE

A

Slipped upper femoral epiphysis

Affects the proximal femoral physis which leads to slipping of the metaphysis relative to the epiphysis

35
Q

What are the risk factors for SUFE

A 
Males 
Obesity 
Endocrine disorders 
Rapid growth spurts = physis cant cope with sudden increase in weight/pressure 
Can be triggered by minor trauma
36
Q

What ages are normally affected by SUFE

A

10-16

Common to have rapid growth

37
Q

How do patients present with SUFE

A

Groin pain
Pain in the knee or thigh
Limp - antalgic or externally rotated foot
Restricted IR and abd

38
Q

How do you diagnose SUFE

A

Radiographs
MRI
-Looks like ice cream falling off the cone (head of femur off)

39
Q

How do you treat SUFE

A

Surgery
Percutaneous pinning of the hip
May have to do open reduction if severe
Often do the other side prophylactically

40
Q

List 4 common congenital paediatric orthopaedic condtions

A

Clubfoot
Rocker bottom foot
Neurofibromatosis
Skeletal dysplasia

41
Q

List 4 common neruromuscualr paediatric orthopaedic condtions

A

Cerebral palsy
Duchenne muscular dystrophy
Cavus foot

42
Q

What is the proper medical name for clubfoot

A

Congenital Talipes Equinovarus CTEV

43
Q

What are the key features of clubfoot

A

Cavus - high arch
Adductus - foot turned inwards
Varus - heel points inward
Equinus - fixed flexion

44
Q

Who gets club foot

A

More boys than girls

1/2 of cases are bilateral

45
Q

What causes club foot

A

Mostly idiopathic

May be associated with more severe neuro conditions such as spina bifida

46
Q

How do you treat club foot

A

Ponseti method
Repeated casting of feet that gradually brings them to normal position
Sometimes the Achilles is cut to allow this but it will heal

47
Q

What is the proper name for rocker bottom feet

A

Congenital vertical talus

48
Q

What causes rocker bottom feet

A

Irreducible dislocation of talus on navicular

Associated with more serious pathologies

49
Q

What are the features of rocker bottom feet

A

rounded plantar surface

Equinus hindfoot -fixed position

50
Q

What is neurofibromatosis

A

Congenital disorder - autosomal dominant

Affects the extremities, spine and skin

51
Q

What are some key signs of neurofibromatosis

A 
>6 café au lait spots 
>2 neurofibromas 
Freckles in axilla or inguinal 
Optic glioma (optic nerve tumour) 
>2 lisch nodules (in sclera) 
Cortical thinning or pseudoarthritis
52
Q

What are skeletal dysplasia’s

A

Refers to many congenital disorders that involve the bone and cartilage
Abnormal development

53
Q

What are features of skeletal dysplasia

A

Shorterning of involved bone
Often short stature
Can be proportionate or disproportionate

54
Q

How can you classify skeletal dysplasia

A

According to area of bone affected
OR
According to pathophysiology

55
Q

What is the most common form of skeletal dysplasia

A

Achondroplasia

Autosomal dominant condition but mostly caused by spontaneous mutations

56
Q

What are the features of achondroplasia

A

Normal trunk with short limbs
Genu varum
Normal intelligence
Motor delay

57
Q

What is cerebral palsy

A

Non-progressive neuromuscular disorder

Common condition

58
Q

what can cause cerebral palsy

A

Prematurity
Traumatic birth
Infection
Meningitis

59
Q

what are some signs of cerebral palsy

A

Muscle weakness
Spasticity
Abnormal muscle forces leading to dynamic deformity
Contracture and fixed deformity

60
Q

What is the most common type of muscular dystrophy

A

Duchenne muscular dystrophy

61
Q

What Duchenne muscular dystrophy

A

Inherited disorder that presents at 2-5 years old
X-linked recessive - affects boys
Muscle gets replaced by fibrofatty tissue - leads to progressive weakness

62
Q

What are the features of Duchenne muscular dystrophy

A

Muscle weakness - greater in proximal muscles
Clumsy walking
Positive Gower’s sign
Scoliosis

63
Q

How do you diagnose Duchenne muscular dystrophy

A

creatine phosphokinase

muscle biopsy

64
Q

What is the prognosis for Duchenne muscular dystrophy

A

Diagnosed age 2-5
Need walking assistance by 10
Wheelchair bound by 15
Many die by 20

65
Q

What is Gower’s sign

A

Walk hands up legs and thighs to get to upright position

Seen in Duchenne muscular dystrophy

66
Q

Describe cavus feet

A

Have an elevated longitudinal arch and varus hindfoot (points in)

67
Q

What can cause cavus feet

A

Idiopathic
Familial
2/3 due to neurological disorder such as polio or cerebral palsy

68
Q

How do you assess cavus feet

A

X-ray

Coleman block test - place block under toes and see if it corrects heel position

69
Q

How do you manage cavus feet

A

Surgery
Soft tissue if flexible deformity
Bone if not flexible

70
Q

What is a greenstick fracture

A

When the break only occurs in one cortex - seen if force applied to one side of bone
The other cortex only bends
Seen in children

71
Q

In children, bones tend to bow rather than break - true or false

A

True

72
Q

What causes a buckle fracture in children

A

Compressive force

Bone buckles in on itself

73
Q

What is a plastic deformation

A

When neither cortex of the bone is broken but it is deformed as bone bends
Seen in very young children

74
Q

Point at which metaphysis connects to physis is an

anatomic point of weakness - true or false

A

True

75
Q

Children’s fractures heal faster than adults - true or false

A

True

76
Q

What are the pros and cons of quick healing fractures in children

A

Pro - shorter immobilization times

Con - mal-aligned fragments become “solid” sooner

77
Q

Until what age can you expect bone remodelling after a fracture

A

Anticipate remodeling if child has > 2 years of

growing left

78
Q

What is the most common elbow fracture seen in children

A

Supracondylar

This is the weakest part of the elbow joint

79
Q

What is the fat pad sign

A

Sign of supracondylar elbow fracture
Sail shaped fat shadow seen on X-ray - anterior portion may be normal but posterior is always pathological
It may be the only sign in a non-displaced fracture

80
Q

What other system must you always check in a supracondylar fracture

A

Vascular!
Always check the pulse as there is a risk of vascular compromise - may need reduced

Neuro - check function is intact

81
Q

How do you treat a supercondylar fracture

A

Mostly conservatively

If displaced and damaged you can manipulate under anaesthetic and place wires

82
Q

Majority of fractures in child < 1 year are from

abuse - true or false

A

True

Must consider NAI in all cases

83
Q

Where are the most common fracture sites in NAI

A

Femur
Humerus
Tibia

84
Q

What would make you suspect NAI

A

Unexplained fractures in different stages of
healing
Femoral fracture in child < 1 year
Scapular fracture in child
Epiphyseal and metaphyseal fractures of the long
bones

MSK (21 decks)

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