Paeds orthopaedics Flashcards
- Septic arthritis is most common in children of what age?
under 4
- Septic arthritis is a common and important complication of
joint replacement
- Septic arthritis presentation
- …is the most common causative organism of septic arthritis. Other bacteria include:
Septic arthritis differentials
Investigation findings and management of septic arthritis
Slipped upper femoral epiphysis (SUFE) definition
head of the femur is displaced (“slips”) along the growth plate
Slipped upper femoral epiphysis (SUFE) more common in which group? Typical age presentation
It is more common in boys and typically presents aged 8 – 15 years, with the average age of 12 in boys.
It presents slightly earlier in females, with an average age of 11 years.
It is more common in obese children.
Slipped upper femoral epiphysis (SUFE) presentation including examination findings
SUFE investigations
The initial investigation of choice in SUFE is xray.
Other investigations that can be helpful in establishing the diagnosis are:
- Blood tests are normal, particularly inflammatory markers used to exclude other causes of joint pain
- Technetium bone scan
- CT scan
- MRI scan
SUFE management
Surgery is required to return the femoral head to the correct position and fix it in place to prevent it slipping further.
Perthes disease definition and age group
Perthes disease main complication
Perthes presentation
perthes vs SUFE differentation in presentation
no history of trauma in perthes. If the pain is triggered by minor trauma —> slipped upper femoral epiphysis, particularly in older children.
investigations in perthes
Perthes management
Reactive arthritis definition and presentation
Reactive arthritis involves synovitis in one or more joints in response to an infective trigger.
Typically it causes acute monoarthritis, affecting a single joint (most often the knee), presenting with a warm, swollen and painful joint.
reactive arthritis important differential
A significant differential is septic arthritis, where an infection is inside the joint. Patients with reactive arthritis do not have an infection in the joint.
The most common triggers of reactive arthritis are
gastroenteritis or sexually transmitted infections.
Chlamydia may cause reactive arthritis.
Gonorrhoea typically causes septic arthritis rather than reactive arthritis.
Reactive arthritis is what type of arthropathy?
seronegative spondyloarthropathy
There is a link with the HLA B27 gene
Reactive arthritis is more common in patients with
HIV
(HIV needs to be excluded in patients with reactive arthritis)
Reactive arthritis associated conditions
- Bilateral conjunctivitis (non-infective)
- Anterior uveitis
- Urethritis (non-gonococcal)
- Circinate balanitis (dermatitis of the head of the penis)
TOM TIP: The classic triad of conjunctivitis, urethritis and arthritis are remembered with the mnemonic, “can’t see, pee or climb a tree”.
Reactive arthritis investigations and management
DDH definition and what it leads to
How is DDH usually picked up?
DDH is either picked up during the newborn examinations or later when the child presents with hip asymmetry, reduced range of movement in the hip or a limp.
Risk factors of DDH
Screening for DDH including examination findings
Diagnosis of DDH
Management of DDH
Transient synovitis cause
temporary (transient) irritation and inflammation in the synovial membrane of the joint (synovitis).
It is the most common cause of hip pain in children aged 3 – 10 years.
It is often associated with a recent viral upper respiratory tract infection.
the most common cause of hip pain in children aged 3 – 10 years
transient synovitis
transient synovitis vs septic arthritis
Children with transient synovitis typically do not have a fever. Children with joint pain and a fever need urgent management for septic arthritis.
Transient synovitis presentation
Transient synovitis management
Transient synovitis prognosis
Typically there is a significant improvement in symptoms after 24 – 48 hours. Symptoms fully resolve within 1 – 2 weeks without any lasting problems. Transient synovitis may recur in around 20% of patients.
Rickets definition
Rickets is a condition affecting children where there is defective bone mineralisation causing “soft” and deformed bones. In adults the same process leads to a condition called osteomalacia. Osteo– means bone and –malacia means soft.
Rickets causes
- deficiency in vitamin D or calcium
- rare form of rickets caused by genetic defects that result in low phosphate in the blood.
This is called hereditary hypophosphataemic rickets. The most common form is x-linked dominant, however it also has other modes of inheritance.
Which conditions tend to have vitamin D deficiency?
- Patients with malabsorption disorders (such as inflammatory bowel disease) are more likely to have vitamin D deficiency.
- The kidneys are essential in metabolising vitamin D to its active form, therefore vitamin D deficiency is common in chronic kidney disease.
Inadequate vitamin D leads to…
Presentation of rickets
Bone deformities that can occur in rickets include:
Risk factors to ask in history of rickets
risk factors for vitamin D deficiency in your exams and clinical practice.
Patients with rickets are likely to have risk factors such as
* darker skin
* low exposure to sunlight
* live in colder climates and
* spend the majority of their time indoors.
Investigations for rickets
Management of rickets
An older child with missed DDH may present with
An older child with missed DDH may present with a Trendlenberg gait and leg length discrepancy
