paediatrics ortho Flashcards by Helen Jones

“limping child” main ortho problems in children 9

fracutre
Hip DDH
perthes
SCFE
Septic 
transient synovitis
osteomyelitis
malignancy 
NAI

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what anatomical feature of children’s bones make it different to adults

physis
periosteum thick
ossification centres

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how are paediatric fractures different to adults

heal quicker
less morbidity
tolerate bed rest beter
more closed reductions ie MUA than open
thick periosteum aids conservative management
physeal
ability to remodel with time

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treatment option for paediatric forearm#

MUA
k wires and nails
remodelling

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Treatment for femoral #

bed traction
flexible nails
physeal consider

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what considerations are there for the physis

risk of growth problems
partial/ complete arrest
articular involvemnet

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age of physis fusion

12-14

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salter harris classification and treatment

straight=conservative
above=conservative
lower=operate
through=operate
physis= crush injury so might need to fuse other leg
I-V

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what ages do
DDH
perthes
and SCFE present at

DDH=toddler
perthes=younger 3-5
SCFE=9-15

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What is DDH

-disorder of abnormal development acetabular dysplasia
-capsular laxity
ie hip not in socket

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meaning of dysplasia

a hip that can be provoked to dislocate or is subluxed

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3 tests to dx of DDH and when should it be diagnosed

positive ortolani sign: abducts the hip while applying ant force= reduces hip joint from dislocate
Positive barlow sign= adducts the hip while applying post force= hip will dislocate from reduced
within first 3 months of life
also use USS

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incidence of DDH

most common MSK

1: 000 dislocated
1: 100 dysplasia

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most common presetnation of DDH 4

unilateral 80%
mostly left hip
limited hip abduction
leg length difference

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risk factors for DDH 6

first born 
female 6:1
breech position
FHX
oligohydramnios: less amniotic fluid
congential abnormalities

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Treatment of DDH by age of dx

6-18 months= spica cast
>18 months: open reduction and cast
>24 months: femoral/ pelvic osteotomy

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what is perthes

idiopathic avascular necrosis of proximal femoral epiphysis

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incidence of perthes

1 in 1000

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age of perthes

4-10

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perthes bilateral or unilateral

more common unilateral 88%

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male to female ratio perthes

5:1 male to female

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risk factors for perthes

fhx
low birth weight
second hand smoke
lower SES

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2 main theories behind perthes

temporary interruption of blood supply to head get increased bone density and impaired physis growth
and
environmental influence: smoke, trauma

pathoanatomy of perthes

disruption in vascular supply
bone collapses and subsequent remodel
abnormal response to minor trauma

perthes worse prognosis factors

age >6 female sex decreased hip range of motion-stiff hip

clinical features of perthes

Tredelenburg gait pain loss of IR and abduction leg length diff

perthes treatment

observation as self-limiting | surgery in minority

when is a pelvic/ femoral osteotomy indicated for Perthes

older children >8 | more severe disease and femoral head collapse

What is SCFE and what happens to the femoral neck

Disorder of the proximal femoral physis leads to slippage of physis relative to femoral neck posterior and internal rotation of femoral neck

incidence of scfe

10 per 100,000

risk factors for scfe 4

obese children males 3:2 african americans pacific islanders

average age for boys and girls

8-15 boys=13.4 girls=12.2 assoc. to puberty

clinical presentation scfe

``` 8-15 obese endocrinopathy short ER hip loss of IR and abduction of hip can't bear weight no trauma hx ```

management scfe

all require operative pinned in situ- no reduction in edinburgh prophylactic fixation of other hip

risk of contralateral side slip for scfe in one year

50%

complications of SCFE

chondrolysis avn secondary OA

what is the line called in scfe where the femoral neck misses the femoral head

klein line

septic arthritis commonest form of spread

haematogenous

commonest age of septic arthritis in kids

50% under age of 2

pathogens for septic arthritis

neonates: staphylocci, streptococci s.aureus h.influenzae drug user: e.coli and pseudonomas sti; neisseria gonorrhoea

routes of septic arthritis

haematogenous extension from adjacent bone direct inoculation from trauma/ surgery

kochers criteria for septic arthritis

``` must have 3/4 for a 90% certainty wbc >12,000 inability to weight bear fever >38.5 esr >40 or crp >20 ```

poor prognostic indicators for septic arthritis

age <6 months osteomyelitis hip versus knee delay >4 days till presentation

sepsis 6

``` give oxygen aspirate joint/ culture empirical antibiotics fluids measure lactate measure urine output ```

what is transient synovitis

looks like septic arthritis but less severe | inflammatory secondary to reactive arthritis in children

clinical presentation of TS

may have fever and raised CRP can be well and no pus often follows a URTI aspirate no culture

management TS

self-limiting | analgesia

what is osteomyleitis

infection of bone

why are children at risk of osteomyelitis

rich metaphyseal blood supply and immature immune system

usual osteomyelitis spread

from haematogenous

clinical presentation osteom

pain inability to weight bear fever maybe x-ray often normal first 2 weeks

causes of osteom

rare TB and kingella causes

red flags for malignancy in a child

constant night pain systemic symptoms swelling

what is NAI

inconsistent history or delay seeking medical attention | ie child abuse

what specific injuries might be an NAI

long bone fracture <2 posterior rib# metaphyseal corner