Paeds Written - MSK Flashcards
Criteria to manage a case of Transient Synovitis in primary care
Has to be all of these:
Aged 3-9 Afebrile Well child Mobile but limping Had Sx for <72 hours
Septic arthritis Tx
Joint aspirate
THEN start empirical Abx
- 4-6 weeks
- can swap to oral after 2 weeks if improving
+ Arthroscopic washout?
Definitive Tx for DDH
Pavlik harness if <4-5 months
Older = surgery
Pathophysiology of Perthes’ disease
Impaired blood supply to femoral head
Results in avascular necrosis of femoral epiphysis
When is limb shortening observed in Osteosarcoma (of femur)?
If pathological fracture occurs
Otherwise, not seen.
Pathophysiology of SUFE
Displacement of femoral head postero-inferiorly
Acute or chronic, persistent
RF for SUFE
Obesity!! Family Hx Endo: Hypothyroidism, pituitary tumour, renal osteodystrophy Down's syndrome Trauma
Diagnostic findings on imaging in SUFE
Displaced femoral head - infero-laterally
Klein’s line (superior edge of femoral neck) intersects less of femoral head
Southwick angle - gives indication of severity
Criteria for assessing likelihood of septic arthritis in child?
Kocher’s criteria
Non weight bearing
Fever >38.5
WCC >12
ESR > 40
1 point = 3%, 4 points = 99%
Common sites of osteomyelitis
Distal femur
Proximal tibia
Osteomyelitis Tx
2-4 weeks IV Abx
- 1st line = Flucloxacillin
- penicillin allergic = clindamycin
- MRSA = vancomycin
Switch to oral once CRP normal
+ surgical debridement if evidence of dead bone or biofilm
Ottawa rule for X-Raying ankle
Pain in malleolar zone and
- bone tenderness at posterior edge or tip of lateral malleolus OR
- bone tenderness at posterior edge or tip of medial malleolus OR
- inability to bear weight immediately AND in ED for 4 steps
Pain in mid-foot zone and
- bone tenderness at base of 5th metatarsal OR
- bone tenderness at navicular OR
- inability to bear weight immediately AND in ED for 4 steps
Ottawa rule for X-Raying knee
Any of:
Age 55+
Isolated patellar tenderness
Cannot flex to 90 degrees
Inability to weight bear immediately AND in ED for 4 steps
Sedation for manipulation of fracture
1st line = intranasal / oral midazolam OR Nitrous oxide 2nd line (or severe) = intranasal ketamine
XR changes in Perthes’ disease
Joint space widening (early)
Decreased femoral head size / flattening (late)
Femoral head fragmentation (very late)
Perthes’ disease Tx options
Cast, braces - to keep femoral head within acetabulum
<6 years = observation
Older = surgery
+ Physiotherapy
Pathophysiology of Osgood-Sclatter disease
Multiple small avulsion fractures from quadriceps’ contraction at their insertion into proximal tibial apophysis
Causes inflammation of cartilage/bone
Clinical features of Osgood-Schlatter disease
Localised tenderness/swelling over tibial tuberosity
Gradual onset pain worse AFTER exercise - relieved by rest
Chondromalacia patellae Clinical features
Anterior knee pain
Exacerbated by running, climbing stairs, getting up after prolonged sitting
O/E:
Painless passive movement
Repeated extension –> pain, Grating sensation
Osteochondritis dissecans clinical features
Pain after exercise
Catching, locking, giving way
Indications for USS Screening of DDH:
Breech presentation at any time after 36/40 (even if not born breech)
First degree family member with early life hip problems
Multiple pregnancy
Tests for DDH at 6-8 week baby check
Barlow = attempt to dislocate Ortolani = attempt to relocate
Features of benign idiopathic nocturnal limb pains of childhood (growing pains)
NOT present at start of day / after waking Intermittent Worse after day of vigorous activity No limp or limitation on activity Systemically well Normal examination Normal motor milestones
