Paeds Orthopaedics Flashcards
Define short stature
Heigh < 3rd centile
Most will not have a pathological reasons
Name five normal variations in kids
Knee alignment Rotational Profile Flat feet Curly Toes Cavus Feet
Describe the natural progression of knee alignment
Children at birth have varus knees which become neutrally aligned at 14 months progressing to 10-15degrees valgus at 3 years old
When is genu varum abnormal?
Abnormal if unilateral, >2SD from mean, short stature, painful
What can cause genu varum?
Skeletal dysplasia Rickets Tumours Trauma - physical injury Blounts disease (arrest of medial tibial physis)
When is genu valgum abnormal?
Asymmetrical, >2SD, painful, intermalleolar distance >8cm age 11
What can cause genu valgum?
Tumours, rickets, neurofibromatosis, idiopathic
Name three variations in rotational profile
Intoeing
Femoral neck anteversion
Internal tibial torsion
Metatarus adductus
Describe flexible flat feet
Arch forms with dorsiflexion usually due to ligamentous laxity/tightness gastrosoleous complex
Describe fixed flat feet
Flat regardless of load/flexion implies underlying bone abnormality
What is tarsal coalition?
Bones of hind foot have an abnormal bony cartilaginous connection
- stand on hip toes ankle will move in
What is developmental hip dysplasia?
Subluxation or dislocation of hip during perinatal period affects the joint development - more common in girls and left
State the risk factors for hip dysplasia?
Family History Breech First Born Congenital disorders Hypermobility due to relaxin receptors Oligohydramnios Down's syndrome
How is hip dysplasia diagnosed?
Examination
Ultrasound
Ortolani test
Barlow test
What are ortolani and barlow tests?
Ortolani - reducing a dislocated hip with abduction and displacement
Barlow - adduction and depression dislocates a susceptible hip
How is hip dysplasia managed?
Pavlik harness
Open reduction
Surgery if late presentation
What will a late presentation of hip dysplasia look like?
Trendelenburg gait
Avascular necrosis
What is meant by SUFE?
Slipped Upper Femoral Epiphysis
What is SUFE?
Displacement thought the growth plate with the epiphysis slipping down and back
What are the risk factors for SUFE?
Obesity
Hypothyroidism
Male
Renal Disease
How is SUFE diagnosed?
Knee pain
Antalgic gait, short/rotated lower limb
Loss of internal rotation
How is SUFE treated?
Surgery - pin or replacement
Severe cases may require osteotomy
What is transient synovitis?
Inflammation of the synovial often secondary to viral illness
How will transient synovitis present?
Limp and hip/groin pain
Flexed/externally rotated
Apyrexial
Resisted range of movement
How is transient synovitis diagnosed?
Kocher criteria
Ultrasound +/- aspiration
Why is septic arthritis a surgical emergency?
High bacterial load
Destruction of joint due to proteolytic enzymes
Osteonecrosis due to pressure
How will septic arthritis present?
Rapid onset, unable to bear weight, hip flexed/externally rotated, severe pain, pyrexia
Describe the pathophysiology of septic arthritis
Direct inoculation from trauma
Haematogenous spread
Extension from adjacent bone - osteomyelitis
How is septic arthritis diagnosed?
Blood test and culture
Kocher criteria
Radiographs
Ultrasound and aspiration
How is septic arthritis treated?
Open surgical washout
Antibiotics
Name three knee problems that can present in kids
Extensor Mechanism problems
Adolescent knee pain
Osteochondritis Dissecans
Meniscal problems
Describe patellar tendonitis
Jumper’s knee - self limiting but may require physio
Describe apophysitis
Inflammation of a growing tubercle where tendon attaches due to repetitive strain
Name the apophysitis depending on which tubercle
Tibial - Osgood Schlatter’s
Inferior pole of patellar - Sinding-Larsen- Johanssen
What is patellofemoral dysfunction associated with?
Muscle imbalance
Ligamentous laxity
Skeletal predisposition - genu valgum, wide hips, femoral neck anteversion
Softening of hyaline cartilage - chondromalacia
If patellofemoral dysfunction persists what can be done?
Surgery to shift forces on the patella
What is osteochondritis dissecans?
Fragment of cartilage with some bone breaks off the surface of the joint
Where does osterochondritis dissecans most commonly occur?
Medial femoral condyle of the knee
How does osteochondritis dissecans present?
Pain, effusion, locking
How is osteochondritis dissecans diagnosed and treated?
MRI
Surgery to remove fragments or fix lesions
What meniscal tears commonly occur in kids?
Peripheral
Bucket handle
Define cerebral palsy
Non-progressive damage to the encephalon occurring before the growth of the CNS is complete at age 3
Name the causes of cerebral palsy
Genetic Brain malformation Intrauterine infection Prematurity Intra-cranial haemorrhage Hypoxia Meningitis Problems during labour
Name three types of cerebral palsy
Spastic
Ataxic
Athetoid
How does spastic CP arise?
Loss of LMN inhibition due to damage to UMN
- hyperreflexia
- clonus
- spasticity
- co-contraction
Describe ataxic CP
Affects cerebellum reducing co-ordination and balance
Describe athetoid CP
Affects extrapyramidal motor system, pyramidal tract and basal ganglion resulting in speech and ton problems
How does CP affect the spine?
Can affect lung function
Scoliosis
What treatment is available for CP?
Botox, baclofen
Physio, splints
Surgery
What disease is tip toe walking associated with?
Autism
What is club feet?
Structural deformity more common in males.
Abnormal alignment of foot joints
Corrected by ponseti technique
What is rocker bottom feet?
Opposite to club foot and treatment is the same but in reverse ponseti technique
What are growing pain red flags?
Asymmetry Localised Rapid onset Persisting limp Not thriving Worsening
What is spina bifida?
Congenital disorder where two halves of the posterior vertebral arch fail to fuse
What causes spina bifida?
Low folic acid
Family history
Medications
Name the two types of spina bifida
Occulta
Cystica
Describe spina bifida occulta
High arched foot
Clawing of toes
Dimple/tuft over defect
Neurological symptoms
Describe spina bifida cystica - name two types
Contents of the vertebral canal herniate through defect
Meningocele - herniation of meninges
Myelomeningocele - meninges and spinal cord/cauda equina
How is spina bifida cystica managed?
Defect closed within 48 hours of birth
Treat hydrocephalus with shunt
Correct scoliosis, hip and contractures by surgery
What is another name for osteogenesis imperfecta?
Brittle bone disease
What is OI?
Defect of the maturation and organisation of type 1 collagen
What are the features of OI?
Multiple fractures
Short stature
Blue sclera
Loss of hearing
How do skeletal dysplasias arise?
Due to genetic error resulting in abnormal development of bone/connective tissue
What is achondroplasia?
Disproportionately short limbs, prominent forehead and widened nose. Joints are lax.
Name four connective tissue disorders
Joint laxityy
Marfan’s
Elher Danlos
Down Syndrome
What are the associated features of Marfans?
Scoliosis High arched palate Flattening of the chest Eye problems Cardiac disease
