Paeds Flashcards
Clinical findings of congenital muscular torticollis?
Plagiocephaly
Facial asymmetry
Decreased neck movement
Etiology of congenital muscular torticollis?
Birth trauma
Vascular
Compartment syndrome
Causes of painful limp?
Infection
Inflammation
Osteochondrosis
Trauma
Tumour
Infection in painful limp?
Hip & Knee - Septic arthritis
LL - osteomyelitis
Inflammation in painful limp?
Hip = TSH, JRA
Knee, Ankle, Foot = JRA
Transient synovitis of hip?
4-8 yo
Hx of URI in past 2 weeks
Looks well
No fever
Differentials of TSH?
Inflammatory arthritis
Perthes Disease
Septic arthritis
Manifestation of Perthes?
4-10yo, mostly boys
Short for age
Bone age 2-3 years behind chronological age
EArly complications of Supracondylar frac?
MN damage [AIN]
Artery [Brachial] - compt syndrome, Volkmann’s
UN damage
Late complications of supracondylar frac?
Non-union
Malunion -> CUBITUS VARUS
Stiffness
Gartland classification for supracondylar frac?
1 = undisplaced
2 = displaced in 1 plane
3 = Displaced in 2/3 planes
4 = complete periosteal disruption with instability in flexion and extension
Treat with cast for Type 1
CRPP most common for 2/3/4
What is Iselin’s disease?
Caused by traction apophysitis of the the peroneus brevis tendon at the tuberosity of the fifth metatarsal in children and presents with lateral foot pain.
What is Osgood Schlatter’s disease?
osteochondrosis or traction apophysitis of the tibial tubercle, commonly presenting as anterior knee pain
Just manage with NSAIDs + activity modification
How to diagnose Osgood Schlatter’s
Clinical diagnosis with **enlarged tibial tubercle **
XR shows irregularity and fragmentation of the tibial tubercle
How to diagnose Iselin’s disease?
Clinical diagnosis with pain over 5th MT base.
XR shows enlarged apophysis with disordered ossification and widened chondro-osseous junction.
When to confirm diagnosis of DDH?
With **US in first 4 months, **
Radiographs 4-6 months after femoral head ossification occurs
Treatment options for DDH?
Pavlik bracing
Surgical reduction, osteotomy etc.
In which hip is DDH more common?
In left hip [60%]. Due to more common intrauterine position being occiput anterior
Bilateral in 20%.
DDH is a spectrum that includes ____
5 things
Dysplasia
Subluxation
Dislocation
Teratologic hip
Late (adolescent) dysplasia
What conditions is DDH a/w?
Congenital muscular torticollis 20%
Metatarsus adductus 10%
Congenital knee dislocation
Classification of DDH?
Subluxable = Barlow-suggestive
Dislocatable = Barlow-positive
Dislocated = Ortolani positive early if reducible
Ortolani-negative late when irreducible dislocation
PE confirmation for DDH?
Barlow = dislocates a dislocatable hip by adduction and depression of flexed femur
Ortolani = reduces dislocated hip by elevation + abduction of flexed femur
Barlow = “Click of exit”
Ortolani = “click of entry”
Barlow-Ortolani rarely positive after 3 months
What PE to do from 3 months - 1 year for DDH?
Limitations in hip abduction.
Occurs as laxity resolves and stiffness begins to occur.
LLD predominates
**Salter-Harris **classification to grade fractures in kids that involve physial plate?
Separated GP
Above GP
Below GP
Through GP
ERasure of GP
GP = Growth plate
Common age for Transient Synovitis of Hip?
4-8 years
MUST be differentiated from septic arthritis of hip
M:F ratio 2:1
RF for transient synovitis?
**URTI Hx in last 2 weeks **
Bacterial infection
Trauma
Allergy
What is natural position of hip in Transient Synovitis?
Flexion, abduction, external rotation
Lowest intracapsular pressure
Presentation of Transient Synovitis of hip?
Groin/Hip pain.
Limp (main)
No fever
MUST be differentiated from septic arthritis
Mx for Transient Synovitis of hip?
Just rest. NSAIDs if want meds
If symptoms improve with NSAIDs, then likely TS
How to differentiate btw TS and septic arthritis?
CRP<20mg/l in TS. Most impt factor TRO Septic arthritis.
Invasive studies of synovial fluid aspiration can also be done
What is Perthes disease?
Coxa Plana
Idiopathic AVN of proximal femoral epiphysis in children
Can cause Trendelenberg gait
Usually unilateral. If bilateral, think skeletal dysplasia instead
Mx of Perthes’ Disease?
Observation/symptomatic if <8yo
Femoral and/or pelvic osteotomy >8yo
Symptomatic can mean like simply restoring ROM or analgesia
What is teratologic dislocation of hip?
Congenital dislocation which is irreducible by gentle manipulation at birth
What is Slipped capital femoral epiphysis
Slippage of metaphysis relative to epiphysis.
Common in adolescent obese males
More common in left hip. But can be bilateral too
Mx for Slipped capital femoral epiphysis?
Usu percutaneous pin fixation.
Contraleteral pinning for high risk patients.
Secondary causes or RFs for SCFE?
Fat, pubertal boys
Endocrine causes -> hypoT, hypoGonadism etc. They weaken physis + overgrowth
Bilateral SCFE points towards endocrine
Presentation of SCFE?
Knee pain + painful limp + Hip/groin pain
Can have referred pain to ant thigh or knee
What is Osteochondritis Dissecans
Separation of small osteocartilaginous fragment from femoral condyle articular surface, usu a/w hx of trauma
Poorly localized knee pain. Activity related.
When does osteochondritis dissecans occur?
10-15 yo when physis still open.
Adult form exists too.
Physiological evolution of leg alignment?
-18 months = Genu varus (tibial intorsion)
1.5yo - 2 yo = Neutral
2 - 6yo = Genu valgum (Ligamentous laxity)
7 yo = Normal valgus angle (<12˚)
What is Chondromalacia Patellae?
Idiopathic articular changes to patella causing anterior knee pain
Mostly adolesents and young adults
PE of chondromalacia patellae?
Quadriceps atrophy
Patella maltracking
Palpable crepitus
Pain with patellar compression
Limited knee ROM
XR findings of Chondromalacia patellae?
May see chondrosis on XR
Shallow sulcus, patella alta/baja, lateral patella tilt
What is Kohler’s disease?
Avascular necrosis of navicular bone.
Pain on dorsal and medial surface of foot
Postural vs Structural scoliosis?
Secondary tilt to compensate for extra-spinal conditions
vs
Fixed primary tilt a/w abnormal bone & vertebral rotation
Mx of frac or dislocation in kids?
If frac close to growth plate, remodelling potential is great and not much is needed.
Child under 10 = remodelling even with 100% displacement
Pre-pubertal = Under 20deg angulation is acceptable
