Pediatric Orthopedic

Question 1

What is DDH?

Answer 1

Congenital anomaly of the hip either:

• complete dislocation of the hip
• dysplasia of the acetabulum (shallow)

Question 2

When is DDH detected?

Answer 2

At birth.

Question 3

Is DDH congenital or traumatic?

Answer 3

Conginital (has nothing to do with mode of delivery)

Question 4

What are the risk factors for DDH

Answer 4

1- breach presentation 
2- family history of DDH 
3- First born 
4- Boys 
5- Oligohydromenos (small uterus) 
6- ligamentous laxity 
7- prematurity & post-maturity
8- birth weight >4kg 
9- race
10- swaddling

Question 5

What will you find the examination of DDH child?

Answer 5

Asymmetrical skin fold “if unilateral”and limited (Ab)duction

Question 6

What special tests are done to identify DDH?

Answer 6

• galleazzi (difference in knee height & the shorter is abnormal)
• barlows & ortolani

Question 7

Describe the premise of barlow ortolani test:

Answer 7

Barlow: dislocating the hip (adduct hip - posterior force on knee)

Ortolani: relocating hip (abducts hip - anterior force on knee)

Question 8

DDH in older children:

Answer 8

• painless limbing “one longer than the other”

- Waddling gait

Question 9

What is the imaging modality of choice to detect DDH in less than 3 months of age?

Answer 9

Ultrasound. (Less thn 3-4m)

If older x-ray.

Question 10

What to measure in ultrasound for DDH?

Answer 10

Bony and cartilagnous angle

Question 11

How to treat DDH if the child is aged 0-6months?

Answer 11

By pavlic harness

Question 12

How is the pavlic harness usually worn?

Answer 12

In abduction, flexion and external rotation

Question 13

When to follow up DDH with pavlic harnesS?

Answer 13

In 4 month to insure location

Question 14

How to treat DDH if the child is aged 6-12 months?

Answer 14

Closed reduction under GA and arthrogram + Hip spica

Question 15

What if after injection of dye the hip was found to be instable, what is the procedure to be done noting that the child is >6m

Answer 15

Open reduction instead of closed reduction

Question 16

Define physiological bowing:

Answer 16

3-5: vulgus
0-2: varus
After 5: slight vulgus but normal position

Question 17

What are the risk factors for pathological varus

Answer 17

• early walkers
• rickets
• infection\tumor\trauma affecting the growth plate
• blounts disease (tibia)
• skeletal dysplasia

Question 18

In which diseases is bowing affecting the both limbs tibia and femur s

Answer 18

Ricket
&
Skeletal dysplasia

Question 19

In the blounts disease what is affected?

Answer 19

Only the tibia

Proximal, posterior and medial

Question 20

What is the sign found in blounts disease in x-ray

Answer 20

The drop sign

Question 21

What is the deformity in club foot?

Answer 21

• Hind foot: varus & short tendon achilles (equinus)
• mid foot: supination
• Forefoot: adduction

Question 22

Diff between club foot and DDH in prevalamce

Answer 22

DDH is common in females

Question 23

What are the possible causes of club foot?

Answer 23

Molding defect or fibrotic contracture or vascular abnormalities s

Question 24

What is the gold standard treatment club foot (initially)

Answer 24

Manipulation and plaster of paris

Ponsetti casting

Question 25

At the later stage of ponsetti casting, what do we commonly do?

Answer 25

Lengthining for final correction

Question 26

What are the alternative therapies if plaster of paris (ponsetti casting failed)

Answer 26

• soft tissue release: 6m

- bony surgery: 5y

Question 27

What is the commonest organism of septic arthritis

Answer 27

Staph aureus

Question 28

How does septic arthritis usually develop

After: …..

Answer 28

• direct trauma
• hematogenous spread
• ostemylitis

Question 29

What are the clinical signs and symptoms of septic arthrtis?

Answer 29

• Pain\tender\swollen joint
• restricted movement
• muscle spasm
• malaise and fever

Question 30

Why is septic arthritis considered as an emergency

Answer 30

Because you need to drain it immediately to avoid developing it into a sepsis

Question 31

What other investigations you’d like to see in septic arthitis

Answer 31

• ESR\leukocytosis
• Aspiration analyisis
• US: effusion
• x-ray: joint widening and reaction
• blood culture

Question 32

What are the 3 diagnostics in septic arthritis

Answer 32

Wbc, glucose, protein

Question 33

How do we commonly follow up patient with septic arthritis?

Answer 33

CRP (P in 3-4d) and ESR (P 2-3w)

Question 34

what is kocher criteria?

Answer 34

• WBC
• ESR
• Temp
• weight bear

For septic

Question 35

Explain numbers in kocher critre

Answer 35

WBC: 12.000 - ESR >40 - T>38.5

Question 36

What is the gold standard treatment for septic arthritis?

Answer 36

Incisoin and drainage (joint)
+
Systemic anitbiotic (start broad then when identified give specific)
+
Analgesia and bed rest and joint rest (traction, cast, splint)

Question 37

What are the complications of septic arthritis?

Answer 37

1- septicemia 
2- growth plate arrest 
3- osteoarthritis 
4- joint stiffness 
6- AVN(Resorption of femoral head and sublaxation)

Question 38

Differentiate VOC from acute osteomyelitis:

Answer 38

• high grade fever
• high CRP
• collection of superiostium in imaging
• hot on bone scan

Osteomylitis
The rest is similar
Bone pain, swelling, redness, hotness, high ESR, fever

Management: incision and draiange for osteomyltis

Question 39

What is the gold standard differentiation method for VOC and acute ostemylitis

Answer 39

Bone scan