paediatrics ortho Flashcards
“limping child” main ortho problems in children 9
fracutre Hip DDH perthes SCFE Septic transient synovitis osteomyelitis malignancy NAI
what anatomical feature of children’s bones make it different to adults
physis
periosteum thick
ossification centres
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
treatment option for paediatric forearm#
MUA
k wires and nails
remodelling
Treatment for femoral #
bed traction
flexible nails
physeal consider
what considerations are there for the physis
risk of growth problems
partial/ complete arrest
articular involvemnet
age of physis fusion
12-14
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
what ages do
DDH
perthes
and SCFE present at
DDH=toddler
perthes=younger 3-5
SCFE=9-15
What is DDH
-disorder of abnormal development acetabular dysplasia
-capsular laxity
ie hip not in socket
meaning of dysplasia
a hip that can be provoked to dislocate or is subluxed
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
incidence of DDH
most common MSK
1: 000 dislocated
1: 100 dysplasia
most common presetnation of DDH 4
unilateral 80%
mostly left hip
limited hip abduction
leg length difference
risk factors for DDH 6
first born female 6:1 breech position FHX oligohydramnios: less amniotic fluid congential abnormalities
Treatment of DDH by age of dx
6-18 months= spica cast
>18 months: open reduction and cast
>24 months: femoral/ pelvic osteotomy
what is perthes
idiopathic avascular necrosis of proximal femoral epiphysis
incidence of perthes
1 in 1000
age of perthes
4-10
perthes bilateral or unilateral
more common unilateral 88%
male to female ratio perthes
5:1 male to female
risk factors for perthes
fhx
low birth weight
second hand smoke
lower SES
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
