Paeds MUSC Flashcards
What are the most common causes of fracture in a neonate?
Clavicle: from shoulder dystocia
Humerus/ femur: from breech delivery
What is the prognosis for neonatal fracture?
Great
How old does a child have to be prescribed codeine and morphine?
16
How should paediatric fractures be managed?
Pain management
Manipulation and reduction
How old does a child need to be to get a intramedullary nail?
4
What is Perthe’s disease?
Avascular necrosis of the femoral epiphysis from an interruption of blood supply, followed by re-vascularisation + re-ossification over 18-36 months
In which age group/ gender is Perthe’s most common?
4-8y boys
Recall the signs and symptoms of Perthe’s
Insidious presentation: limp, knee pain, hip pain –> limb shortening
What investigations should be done for Perthes?
X ray: AP + frog leg Lateral views
MRI
Roll test: guarding on internal rotation
What would an x ray show in Perthe’s disease?
Increased density of femoral head
Femoral head fragmentation/ sclerosis
What is the roll test?
Patient supine, roll affected hip internally + externally –> guarding or spasm in Perthe’s
How is Perthe’s managed?
Simple analgesia for pain Mx
<6y: observation/ non-surgical containment using splints
>6y: surgery
What is Osgood Shlatter Disease?
Osteochondritis (inflammation of cartilage/ bone) of the patellar tendon insertion at the knee
Recall the most at-risk group for OSD?
10-15y who are physically active
Recall the signs and symptoms of OSD?
Gradual onset knee pain after exercise that is relieved by rest
Localised tenderness + swelling over tibial tuberosity
Hamstring tightness
What might be seen on X ray in OSD?
Fragmentation of the tibial tubercle + overlying soft tissue swelling
How should OSD be managed?
Simple analgesic packs (intermittent)
Protective knee pads
Stretching
Reassure - this will resolve over time, but may persist until end of growth spurt
Advise stopping/ reducing all sporting activity
What is chondromalacia patellae?
Anterior knee pain from degeneration of articular cartilage on posterior surface of patella
What is the general cause of chondromalacia patellae?
Overuse in physical activity
Recall the signs and symptoms of chondromalacia patellae
Anterior knee pain: exacerbated by movement
Painless passive movement but pain + grating sensation on repeated extension
How should chondromalacia patellae be managed?
Physio
What is osteochondritis dissecans?
Idiopathic disease affecting subchondral bone + its overlying articular cartilage due to loss of blood flow.
May result in separation + instability of a segment of cartilage + free movement of fragments within the joint space
Recall the signs and symptoms of osteochondritis dissecans?
Pain after exercise
Catching
Locking
Giving way
What is osteomyelitis?
Infection of metaphysis of long bones, commonly the distal femur + proximal tibia
What is the most common pathogen implicated in osteomyelitis?
Staph aureus
What is the most common age group affected by osteomyelitis?
<5 years
How does the presentation of osteomyelitis compare to the presentation of septic arthritis?
Usually chronic in onset + less severe than septic arthritis (over a week rather than a day)
Recall the signs and symptoms of osteomyelitis?
Fever
Acute onset limb pain, immobile limb, skin swollen, tender + erythematous
What investigations should be done for suspected osteomyelitis?
Septic screen
BCs + FBC
Joint aspiration and MC+S
XR –> MRI of joint (shows soft tissue)
How should acute osteomyelitis be managed?
High dose IV empirical- narrow spec Abx
1st line is flucloxacillin
Take BCs before staring IV Abx
Change to oral Abx as soon as CRP is back to normal
Surgical debridement may be necessary
What is septic arthritis?
Infectious arthritis of the synovial joint (vs osteomyelitis of bone)
Which joint is affected in 75% of cases of septic arthritis?
Hip
What is the usual pathogen implicated in septic arthritis?
S aureus
Recall the signs and symptoms of septic arthritis
Single joint warm
Erythematous
Tender
Reduced range of movement
Infants will hold the limb still
What investigations should be done for septic arthritis?
SAME AS OSTEOMYELITIS
Septic screen
BCs and FBC
Joint aspiration and MC+S
XR –> MRI of joint (shows soft tissue)
How should septic arthritis be managed?
Similar to osteomyelitis but not the same
IV flucloxacillin –> oral
Joint wash out + aspirated to dryness PRN
What is Still’s disease?
Persistent joint swelling presenting before 16 years, in the absence of infection/ other defined cause
What are the signs and symptoms of Still’s?
May be any number of joints
Gelling (stiffness after periods of rest)
Intermittent limp
Morning joint stiffness/ pain
Limited movement
Recall some late signs of Still’s
Inflammation + bone expansion - ‘knock knees’
Salmon-coloured rash (pathogenomic of systemic Still’s)
What investigations should be done in suspected Still’s?
Clinical diagnosis mainly
Bloods + imaging to prove classification + prognostic info
ANA, FBC, RhF, CRP/ESR, anti-CCP
USS/ MRI
How should Still’s be managed?
MDT rheuatology
NSAIDs
Corticosteroids (high to low dose)
DMARDs - if disease fails to respond to conventional treatments - methotrexate or sulfalazine
TNF alpha inhibitors if needed
What is the prognosis for Still’s disease?
Most children can expect good disease control and quality of life
If poor disease control –> anterior uveitis and fractures
What is the former name of reactive arthritis?
Reiter’s syndrome
What are the most likely causative organisms in reactive arthritis?
Enteric bacteria - salmonella, shigella, campylobacter, yersinia
Recall the signs and symptoms of reactive arthritis
Transient joint swelling (<6 weeks) following an extra-articular infection
Low grade fever
Which joints are most typically affected by reactive arthritis?
Ankles/ knees
What investigations should be done in suspected reactive arthritis?
A diagnosis of exclusion as no positive findings
Bloods (CRP normal or mildly elevated)
Normal XR
How should reactive arthritis be managed?
Self-limting, NSAIDs will do for analgesia
What is SUFE?
Displacement of epiphysis of femoral head posteroinferiorly
Why does SUFE need prompt treatment?
To prevent avascular necrosis
What age group is usually affected by SUFE?
10-15 years
What is the biggest RF for SUFE?
Obesity
What are the signs and symptoms of SUFE?
Limp/ hip pain +/- referred to the knee
Insidious or acute onset
“Loss of internal rotation of a flexed hip”
Trendelenburg gait positive
What investigations should be done in suspected SUFE?
Hip XR in AP and frog-lateral view (both hips)
How should SUFE be managed?
Analgesia, bed-bound
Surgical internal fixation at growth plate
What is transient synovitis?
Irritable hip - 3-10 years
What age group is affected by transient synovitis?
3-10 years
What is a red flag for urgent hospital assesment in transient synovitis?
Age <3 with an acute limp
What is the cause of transient synovitis?
Viral infection (so causes a low grade fever)
How should transient synovitis be investigated and managed
Clinically - it is self-limiting
What is DDH?
A spectrum of conditions affecting proximal femur and acetabulum - ranging from subluxation to frank dislocation
What is true DDH?
Femoral head has a persistently abnormal relationship with the acetabulum–> abnormal bony development, premature arthritis and significant disability
What are the 2 manoevres that are key to early detection of DDH?
Barlow: dislocate posteriorly out of the hip
Ortolani: relocate back into acetabulum on hip abduction
What is the biggest RF for DDH?
Female
Recall the signs and symptoms of DDH
Limp/ abnormal
Delayed crawling/ walking: toe-walking
Asymmetrical skin folds
Limb length discrepancy
What age group are the Barlow and Ortolani manoevres appropriate for?
<6 months
What other investigation can be done alongside B and O manoevres in suspected DDH?
USS
What investigation should be done in children too old for B and O manoevres?
X ray
What are the indications for USS neonatally regardless of presentation, and when is this USS done?
Born breech or FH of DDH
Done at 6 weeks
How should DDH be managed in the newborn?
Pavlik harness (most resolve spontaneously by 3-6w)
Keeps hips flexed + abducted
How should DDH be managed in those >6 months old?
Surgery if conservative measures fail or there is no progress with harness
