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Finals > Paeds: Ortho > Flashcards

Paeds: Ortho Flashcards

1
Q

Developmental Dysplasia of the Hip

what bedside test would you use to indicate whether the shortening is femoral or tibial?

A

Galleazi test

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2
Q

Developmental Dysplasia of the Hip

what is it

A

structural abnormality in the hips caused by abnormal development of the fetal bones during pregnancy.

This leads to instability in the hips and a tendency or potential for subluxation or dislocation.

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3
Q

Developmental Dysplasia of the Hip

RFs (4)

A
  • 1st degree FH
  • breech from 36w
  • breech at birth if 28w onwards
  • multiple pregnancy
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4
Q

Developmental Dysplasia of the Hip

when is it screened for

A

on the neonatal examination at birth and 6-8 week old

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5
Q

Developmental Dysplasia of the Hip

Findings that may suggest DDH (5)

A
  1. different leg lengths
  2. restricted hip abduction on one side
  3. significant bilateral restriction in abduction
  4. difference in the knee level when the hips are flexed
  5. clunking of the hips on special tests
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6
Q

Developmental Dysplasia of the Hip

what are the 2 special tests

A

Ortolani test

Barlow test

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7
Q

Developmental Dysplasia of the Hip

what is the ortolani test

A
  • baby on back with hips and knees flexed
  • abduct hips and apply pressure behind the legs
  • see if hips dislocate anteriorly
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8
Q

Developmental Dysplasia of the Hip

what is the Barlow test

A
  • baby on back with hips adducted and flexed at 90 degrees and knees bent at 90 degrees
  • Gentle downward pressure is placed on knees through femur
  • to see if the femoral head will dislocate posteriorly.
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9
Q

Developmental Dysplasia of the Hip

Clicking is a common examination finding, what is it due to

A

soft tissue moving over bone

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10
Q

Developmental Dysplasia of the Hip

what sound is likely to indicate DDH and requires US

A

Clunking

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11
Q

Developmental Dysplasia of the Hip

diagnostic inx

A

US of the hips

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12
Q

Developmental Dysplasia of the Hip

who should get an US

A

All children with risk factors or examination findings suggestive of DDH

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13
Q

Developmental Dysplasia of the Hip

when are x-rays helpful

A

in older infants

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14
Q

Developmental Dysplasia of the Hip

mnx if <6m

A

Pavlik harness

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15
Q

Developmental Dysplasia of the Hip

what is a Pavlik harness

A

hold the femoral head in the correct position to allow the hip socket (acetabulum) to develop a normal shape.

keeps the baby’s hips flexed and abducted.

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16
Q

Developmental Dysplasia of the Hip

when is the Pavlik harness removed

A

when their hips are more stable, usually after 6-8w

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17
Q

Developmental Dysplasia of the Hip

mnx if Pavlik harness fails or >6m

A

surgery, then a hip spica cast is used to immobilise the hip for a prolonged period.

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18
Q

Slipped Upper Femoral Epiphysis

what is it

A

head of the femur is displaced (“slips”) along the growth plate.

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19
Q

Slipped Upper Femoral Epiphysis

who is it more common in

A

obese 8-15yr old boys

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20
Q

adolescent, obese male undergoing a growth spurt. Hx of minor trauma. Likely dx?

A

SUFE

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21
Q

Slipped Upper Femoral Epiphysis

presenting sx

A
  • Hip, groin, thigh or knee pain
  • Restricted range of hip movement
  • Painful limp
  • Restricted movement in the hip
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22
Q

Slipped Upper Femoral Epiphysis

examination findings

A

prefer to keep the hip in external rotation

restricted internal rotation

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23
Q

Slipped Upper Femoral Epiphysis

initial inx of choice

A

x-ray

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24
Q

Slipped Upper Femoral Epiphysis

Other investigations that can be helpful in establishing the dx (apart from x-ray)

A
  • normal blood tests
  • Technetium bone scan
  • CT scan
  • MRI scan
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25
Q

Slipped Upper Femoral Epiphysis

Mnx

A

Surgery

to return the femoral head to the correct position and fix it in place to prevent it slipping further.

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26
Q

Transient Synovitis

aka

A

irritable hip

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27
Q

Transient Synovitis

what is it

A

temporary (transient) irritation and inflammation in the synovial membrane of the joint (synovitis)

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28
Q

what is the most common cause of hip pain in children aged 3-10yrs

A

transient synovitis

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29
Q

Transient Synovitis

what is it often associated with

A

a recent viral upper respiratory tract infection.

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30
Q

Transient Synovitis

what is the difference between this and septic arthritis

A

Children with transient synovitis typically do not have a fever

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31
Q

Transient Synovitis

presentation

A

viral illness, then a few weeks later:

  • limp
  • refusal to weight bear
  • groin or hip pain
  • mild low grade temp

normal paediatric observations and no signs of systemic illness

32
Q

Transient Synovitis

mnx

A

symptomatic: analgesia

A&E if the sx worsen or they develop a fever.

followed up at 48h and 1w

33
Q

Transient Synovitis

prognosis

A

significant improvement in sx after 24 – 48 h

resolve within 1 – 2w without any lasting problems.

may recur in around 20%

34
Q

Perthes Disease

what is it

A

disruption of the blood flow to the femoral head causing avascular necrosis of the bone

35
Q

Perthes Disease

which bone does it affect

A

the epiphysis of the femur (the bone distal to the growth plate: physis)

36
Q

Perthes Disease

epidemiology

A

4-12yrs

mostly 5-8yrs

more common in boys

37
Q

Perthes Disease

cause

A

idiopathic

38
Q

Perthes Disease

main complication

A

a soft and deformed femoral head leading to early hip OA

39
Q

Perthes Disease

presentation

A

slow onset of:

  • pain in hip or groin
  • limp
  • restricted hip movements
  • referred pain to the knee
  • NO HX OF TRAUMA
40
Q

difference between SUFE and Perthes

A

if pain is triggered by minor trauma, think SUFE

41
Q

Perthes Disease

initial inx of choice

A

x-ray

42
Q

Perthes Disease

other inx helpful in establishing dx (other than xray)

A
  • normal blood tests
  • technetium bone scan
  • MRI scan
43
Q

Perthes Disease

initial mnx in younger and less severe disease

A

conservative:

  • bed rest
  • traction
  • crutches
  • analgesia
  • physio
  • regular x-rays

maintain alignment

44
Q

Perthes Disease

mnx in severe cases, older children or those that are not healing

A

surgery

45
Q

Talipes (clubfoot)

what is it

A

a fixed abnormal ankle position that presents at birth

46
Q

Talipes (clubfoot)

what are the 2 types

A

Talipes equinovarus

Talipes calcaneovalgus

47
Q

Talipes (clubfoot)

what is Talipes equinovarus

A

ankle in plantar flexion and supination.

48
Q

Talipes (clubfoot)

what is Talipes calcaneovalgus

A

ankle in dorsiflexion and pronation.

49
Q

Talipes (clubfoot)

trx

A

Ponseti method

surgery if it fails

50
Q

Talipes (clubfoot)

what is the Ponseti method

A

foot is manipulated towards a normal position and a cast is applied to hold it in position.

repeated over and over until the foot is in the correct position.

At some point an achilles tenotomy to release tension in the achilles tendon is performed

51
Q

Talipes (clubfoot)

Ponseti method: mnx after cast

A

a brace is used to hold the feet in the correct position when not walking until the child is around 4 years old ‘‘boots and bars’’

52
Q

Talipes (clubfoot)

what is Positional Talipes

A

the resting position of the ankle is in plantar flexion and supination, however it is not fixed in this position and there is no structural boney issue in the ankle.

muscles are slightly tight around the ankle but the bones are unaffected.

53
Q

Talipes (clubfoot)

mnx of positional talipes

A

physio

resolves over time

54
Q

Osteosarcoma

what is it

A

a type of bone cancer which usually presents in in adolescents aged 10-20 years

55
Q

Osteosarcoma

what is the most common bone to be affected

A

femur

tibia and humerus are also common

56
Q

Osteosarcoma

main presenting features

A

persistent bone pain

worse at night

bone swelling, palpable mass, restricted joint movement

57
Q

Osteosarcoma

child presents with unexplained bone pain or swelling. What do you do

A

very urgent direct access x-ray within 48h

58
Q

Osteosarcoma

If the xray suggests a possible sarcoma, what next

A

need very urgent specialist assessment within 48 hours.

59
Q

Osteosarcoma

what would x-ray show

A
  • poorly defined lesion in the bone
  • destruction of the normal bone and a “fluffy” appearance
  • periosteal reaction (irritation of the lining of the bone) classically described as a “sun-burst” appearance
60
Q

Osteosarcoma

what may blood tests show

A

a raised ALP

61
Q

Osteosarcoma

what further investigations is used to better define the lesion and stage the cancer

A
  • CT scan
  • MRI scan
  • Bone scan
  • PET scan
  • Bone biopsy
62
Q

Osteosarcoma

mnx

A
  • surgical resection of the lesion, often with a limb amputation
  • adjuvant chemo
63
Q

Osteosarcoma

main complications

A
  • pathological bone fractures

- metastasis

64
Q

Osteomyelitis

what is it

A

infection in the bone and bone marrow.

65
Q

Osteomyelitis

where does it typically occur

A

in the metaphysis of the long bones

66
Q

Osteomyelitis

what is the most common bacteria

A

staph aureus

67
Q

Osteomyelitis

what is chronic osteomyelitis

A

a deep seated, slow growing infection with slowly developing symptoms

68
Q

Osteomyelitis

how would acute osteomyelitis present

A

more quickly with an acutely unwell child

69
Q

Osteomyelitis

who is it more common in

A

boys and children under 10 years

70
Q

Osteomyelitis

RFs

A
  • Open bone fracture
  • Orthopaedic surgery
  • Immunocompromised
  • Sickle cell anaemia
  • HIV
  • Tuberculosis
71
Q

Osteomyelitis

presentation

A
  • refusing to use the limb or weight bear
  • pain
  • swelling
  • tenderness
72
Q

Osteomyelitis

initial inx

A

x-ray but can be normal in osteomyelitis

73
Q

Osteomyelitis

diagnostic inx

A

MRI

or bone scan

74
Q

Osteomyelitis

what will bloods show

A

raised inflammatory markers and WBCs

75
Q

Osteomyelitis

how to establish causative organism

A

blood culture

bone marrow aspiration or bone biopsy with histology and culture may be necessary

76
Q

Osteomyelitis

mnx

A

extensive and prolonged antibiotic therapy.

may require surgery for drainage and debridement of the infected bone.

Finals (47 decks)

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