Paeds MSK Flashcards
What’s the most common cause of hip pain in children aged 3-10?
Transient synovitis
What is transient synovitis often associated with?
A recent viral URTI
True/false - Perthes disease is more common in boys
True
What happens in Perthes disease
Disruption of blood supply to the femoral head leading to avascular necrosis of the bone
Will there be a history of trauma in Perthes disease?
No
What is the initial management in Perthes disease?
Conservative - maintain a healthy position and alignment in the joint to promote healing and prevent damage
What happens in slipped upper femoral epiphysis?
The femoral head is displaced along the growth plate
What is the typical profile of a child with SUFE?
Adolescent (ages 8-15), obese male undergoing a growth spurt
What condition is indicated by a history of hip pain/restricted ROM and trauma
Slipped upper femoral epiphysis
How will a patient with SUFE typically hold their hip?
Externally rotated
What is the management of SUFE?
Surgery to fix the femoral head in the correct place
What happens in Osgood-Schlatter disease?
Inflammation at the tibial tuberosity where the patella ligament inserts
Is Osgood-Schlatter disease usually unilateral or bilateral?
Usually unilateral
What is the typical profile of a child with Osgood-Schlatter disease?
Sporty male between ages of 10-15
What the the 3 most common causes of joint pain in patients aged 0-3?
- Septic arthritis
- Developmental dysplasia of the hip
- Transient synovitis
What are the 3 most common causes of joint pain in patients aged 5-10?
- Septic arthritis
- Transient synovitis
- Perthes disease
What the the 3 most common causes of joint pain in patients aged 10-16?
- Septic arthritis
- Slipped upper femoral epiphysis
- JIA
What is osteomyelitis and what’s the most common cause?
- Infection in the bone and bone marrow
- Staph aureus
How is septic arthritis different to osteomyelitis?
Septic arthritis is infection of a joint
What’s the best investigation for diagnosing osteomyelitis?
MRI
What is the management of osteomyelitis?
- Long term antibiotic therapy
- May need surgery to drain and remove the infected bone
Osteosarcoma:
1. Age typically affected
2. Which bone is mos commonly affected
3. What is the main presenting feature
- 10-20
- Femur
- Persistent bone pain
Osteosarcoma diagnosis:
1. What will XR show
2. What blood test may be raised
- A poorly defined lesion in the bone, with destruction of the normal bone and a “fluffy” appearance
- ALP
What is talipes
A fixed abnormal ankle position, present at birth
What are the two different types of talipes?
- Talipes equinovagus - ankle in plantar flexion and supination
- Talipes calcaneovalgus - ankle in dorsiflexion and pronation
What is the management of talipes?
Ponseti method - non surgical correction with physio and casts
Give 3 risk factors for developmental dysplasia of the hips
- 1st degree FHx
- Breech presentation
- Multiple pregnancy
What is the preferred investigation in developmental dysplasia of the hips?
USS
DDH management:
1. What is first line treatment?
2. How does this keep the hips?
3. How long does it stay on for?
- Pavlik harness
- Flexed and abducted
- 6-8 wks
When is surgery indicated in DDH?
If the pavlik harness fails or the baby is >6months
Vitamin D deficiency investigations:
1. What blood test is measured?
2. What value indicates vitamin D deficiency?
3. What investigation is required to diagnose rickets?
4. What might it show?
- 25-hydroxyvitamin D
- <25 mol/L
- XR
- More radiolucent bones
Vitamin D deficiency management:
1. What is the treatment for Vitamin D deficiency
2. What else needs to be replaced in rickets
- Ergocalciferol
- Calcium
What’s the likely diagnosis? What differential requires excluding?
- Young child
- Unusual and recurrent fractures
- Blue discolouration to sclera
- Osteogenesis imperfecta
- NAI
What medications are used in osteogenesis imperfecta?
- Bisphosphonates - increase bone density
- Vit D supplements - prevent deficiency
Do you get a painless limb in Perthe’s or SUFE?
Perthe’s
What is irritable hip?
Transient synovitis with joint effusion
What do Barlows and Ortolanis tests look for?
- Ortalani - does the hip dislocate anteriorly
- Barlow - does the femoral head displace posteriorly
What is the investigation for hip dysplasia in…
1. Child <4 months
2. Child >4 months
- USS
- XR
Give two investigations for Perthes disease
- Roll test - will evoke guarding/spasm
- XR - joint space widening, crescent sign
What criteria can be used for septic arthritis? What is included?
Kocher criteria
- Can’t weight bear
- Temp >38.5
- ESR > 40
- WCC > 12
