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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
Slipped Upper Femoral Epiphysis Mnx
Surgery | to return the femoral head to the correct position and fix it in place to prevent it slipping further.
26
Transient Synovitis aka
irritable hip
27
Transient Synovitis what is it
temporary (transient) irritation and inflammation in the synovial membrane of the joint (synovitis)
28
what is the most common cause of hip pain in children aged 3-10yrs
transient synovitis
29
Transient Synovitis what is it often associated with
a recent viral upper respiratory tract infection.
30
Transient Synovitis what is the difference between this and septic arthritis
Children with transient synovitis typically do not have a fever
31
Transient Synovitis presentation
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
Transient Synovitis mnx
symptomatic: analgesia A&E if the sx worsen or they develop a fever. followed up at 48h and 1w
33
Transient Synovitis prognosis
significant improvement in sx after 24 – 48 h resolve within 1 – 2w without any lasting problems. may recur in around 20%
34
Perthes Disease what is it
disruption of the blood flow to the femoral head causing avascular necrosis of the bone
35
Perthes Disease which bone does it affect
the epiphysis of the femur (the bone distal to the growth plate: physis)
36
Perthes Disease epidemiology
4-12yrs mostly 5-8yrs more common in boys
37
Perthes Disease cause
idiopathic
38
Perthes Disease main complication
a soft and deformed femoral head leading to early hip OA
39
Perthes Disease presentation
slow onset of: - pain in hip or groin - limp - restricted hip movements - referred pain to the knee - NO HX OF TRAUMA
40
difference between SUFE and Perthes
if pain is triggered by minor trauma, think SUFE
41
Perthes Disease initial inx of choice
x-ray
42
Perthes Disease other inx helpful in establishing dx (other than xray)
- normal blood tests - technetium bone scan - MRI scan
43
Perthes Disease initial mnx in younger and less severe disease
conservative: - bed rest - traction - crutches - analgesia - physio - regular x-rays maintain alignment
44
Perthes Disease mnx in severe cases, older children or those that are not healing
surgery
45
Talipes (clubfoot) what is it
a fixed abnormal ankle position that presents at birth
46
Talipes (clubfoot) what are the 2 types
Talipes equinovarus Talipes calcaneovalgus
47
Talipes (clubfoot) what is Talipes equinovarus
ankle in plantar flexion and supination.
48
Talipes (clubfoot) what is Talipes calcaneovalgus
ankle in dorsiflexion and pronation.
49
Talipes (clubfoot) trx
Ponseti method surgery if it fails
50
Talipes (clubfoot) what is the Ponseti method
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
Talipes (clubfoot) Ponseti method: mnx after cast
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
Talipes (clubfoot) what is Positional Talipes
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
Talipes (clubfoot) mnx of positional talipes
physio resolves over time
54
Osteosarcoma what is it
a type of bone cancer which usually presents in in adolescents aged 10-20 years
55
Osteosarcoma what is the most common bone to be affected
femur tibia and humerus are also common
56
Osteosarcoma main presenting features
persistent bone pain worse at night bone swelling, palpable mass, restricted joint movement
57
Osteosarcoma child presents with unexplained bone pain or swelling. What do you do
very urgent direct access x-ray within 48h
58
Osteosarcoma If the xray suggests a possible sarcoma, what next
need very urgent specialist assessment within 48 hours.
59
Osteosarcoma what would x-ray show
- 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
Osteosarcoma what may blood tests show
a raised ALP
61
Osteosarcoma what further investigations is used to better define the lesion and stage the cancer
- CT scan - MRI scan - Bone scan - PET scan - Bone biopsy
62
Osteosarcoma mnx
- surgical resection of the lesion, often with a limb amputation - adjuvant chemo
63
Osteosarcoma main complications
- pathological bone fractures | - metastasis
64
Osteomyelitis what is it
infection in the bone and bone marrow.
65
Osteomyelitis where does it typically occur
in the metaphysis of the long bones
66
Osteomyelitis what is the most common bacteria
staph aureus
67
Osteomyelitis what is chronic osteomyelitis
a deep seated, slow growing infection with slowly developing symptoms
68
Osteomyelitis how would acute osteomyelitis present
more quickly with an acutely unwell child
69
Osteomyelitis who is it more common in
boys and children under 10 years
70
Osteomyelitis RFs
- Open bone fracture - Orthopaedic surgery - Immunocompromised - Sickle cell anaemia - HIV - Tuberculosis
71
Osteomyelitis presentation
- refusing to use the limb or weight bear - pain - swelling - tenderness
72
Osteomyelitis initial inx
x-ray but can be normal in osteomyelitis
73
Osteomyelitis diagnostic inx
MRI or bone scan
74
Osteomyelitis what will bloods show
raised inflammatory markers and WBCs
75
Osteomyelitis how to establish causative organism
blood culture bone marrow aspiration or bone biopsy with histology and culture may be necessary
76
Osteomyelitis mnx
extensive and prolonged antibiotic therapy. may require surgery for drainage and debridement of the infected bone.

Finals (47 decks)

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