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othopaedics > paediatrics ortho > Flashcards

paediatrics ortho Flashcards

1
Q

“limping child” main ortho problems in children 9

A 
fracutre
Hip DDH
perthes
SCFE
Septic 
transient synovitis
osteomyelitis
malignancy 
NAI
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2
Q

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

A

physis
periosteum thick
ossification centres

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3
Q

how are paediatric fractures different to adults

A 
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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4
Q

treatment option for paediatric forearm#

A

MUA
k wires and nails
remodelling

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5
Q

Treatment for femoral #

A

bed traction
flexible nails
physeal consider

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6
Q

what considerations are there for the physis

A

risk of growth problems
partial/ complete arrest
articular involvemnet

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7
Q

age of physis fusion

A

12-14

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8
Q

salter harris classification and treatment

A 
straight=conservative
above=conservative
lower=operate
through=operate
physis= crush injury so might need to fuse other leg
I-V
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9
Q

what ages do
DDH
perthes
and SCFE present at

A

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

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10
Q

What is DDH

A

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

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11
Q

meaning of dysplasia

A

a hip that can be provoked to dislocate or is subluxed

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12
Q

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

A

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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13
Q

incidence of DDH

A

most common MSK

1: 000 dislocated
1: 100 dysplasia

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14
Q

most common presetnation of DDH 4

A

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

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15
Q

risk factors for DDH 6

A 
first born 
female 6:1
breech position
FHX
oligohydramnios: less amniotic fluid
congential abnormalities
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16
Q

Treatment of DDH by age of dx

A

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

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17
Q

what is perthes

A

idiopathic avascular necrosis of proximal femoral epiphysis

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18
Q

incidence of perthes

A

1 in 1000

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19
Q

age of perthes

A

4-10

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20
Q

perthes bilateral or unilateral

A

more common unilateral 88%

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21
Q

male to female ratio perthes

A

5:1 male to female

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22
Q

risk factors for perthes

A

fhx
low birth weight
second hand smoke
lower SES

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23
Q

2 main theories behind perthes

A

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

24
Q

pathoanatomy of perthes

A

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

25
Q

perthes worse prognosis factors

A

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

26
Q

clinical features of perthes

A

Tredelenburg gait
pain
loss of IR and abduction
leg length diff

27
Q

perthes treatment

A

observation as self-limiting

surgery in minority

28
Q

when is a pelvic/ femoral osteotomy indicated for Perthes

A

older children >8

more severe disease and femoral head collapse

29
Q

What is SCFE and what happens to the femoral neck

A

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

30
Q

incidence of scfe

A

10 per 100,000

31
Q

risk factors for scfe 4

A

obese children
males 3:2
african americans
pacific islanders

32
Q

average age for boys and girls

A

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

33
Q

clinical presentation scfe

A 
8-15
obese
endocrinopathy
short ER hip
loss of IR and abduction of hip 
can't bear weight
no trauma hx
34
Q

management scfe

A

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

35
Q

risk of contralateral side slip for scfe in one year

A

50%

36
Q

complications of SCFE

A

chondrolysis
avn
secondary OA

37
Q

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

A

klein line

38
Q

septic arthritis commonest form of spread

A

haematogenous

39
Q

commonest age of septic arthritis in kids

A

50% under age of 2

40
Q

pathogens for septic arthritis

A

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

41
Q

routes of septic arthritis

A

haematogenous
extension from adjacent bone
direct inoculation from trauma/ surgery

42
Q

kochers criteria for septic arthritis

A 
must have 3/4 for a 90% certainty
wbc >12,000
inability to weight bear
fever >38.5
esr >40 or crp >20
43
Q

poor prognostic indicators for septic arthritis

A

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

44
Q

sepsis 6

A 
give oxygen
aspirate joint/ culture
empirical antibiotics
fluids
measure lactate
measure urine output
45
Q

what is transient synovitis

A

looks like septic arthritis but less severe

inflammatory secondary to reactive arthritis in children

46
Q

clinical presentation of TS

A

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

47
Q

management TS

A

self-limiting

analgesia

48
Q

what is osteomyleitis

A

infection of bone

49
Q

why are children at risk of osteomyelitis

A

rich metaphyseal blood supply and immature immune system

50
Q

usual osteomyelitis spread

A

from haematogenous

51
Q

clinical presentation osteom

A

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

52
Q

causes of osteom

A

rare TB and kingella causes

53
Q

red flags for malignancy in a child

A

constant
night pain
systemic symptoms
swelling

54
Q

what is NAI

A

inconsistent history or delay seeking medical attention

ie child abuse

55
Q

what specific injuries might be an NAI

A

long bone fracture <2
posterior rib#
metaphyseal corner

othopaedics (21 decks)

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