Pediatric Orthopedic Flashcards
What is DDH?
Congenital anomaly of the hip either:
- complete dislocation of the hip
- dysplasia of the acetabulum (shallow)
When is DDH detected?
At birth.
Is DDH congenital or traumatic?
Conginital (has nothing to do with mode of delivery)
What are the risk factors for DDH
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
What will you find the examination of DDH child?
Asymmetrical skin fold “if unilateral”and limited (Ab)duction
What special tests are done to identify DDH?
- galleazzi (difference in knee height & the shorter is abnormal)
- barlows & ortolani
Describe the premise of barlow ortolani test:
Barlow: dislocating the hip (adduct hip - posterior force on knee)
Ortolani: relocating hip (abducts hip - anterior force on knee)
DDH in older children:
- painless limbing “one longer than the other”
- Waddling gait
What is the imaging modality of choice to detect DDH in less than 3 months of age?
Ultrasound. (Less thn 3-4m)
If older x-ray.
What to measure in ultrasound for DDH?
Bony and cartilagnous angle
How to treat DDH if the child is aged 0-6months?
By pavlic harness
How is the pavlic harness usually worn?
In abduction, flexion and external rotation
When to follow up DDH with pavlic harnesS?
In 4 month to insure location
How to treat DDH if the child is aged 6-12 months?
Closed reduction under GA and arthrogram + Hip spica
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
Open reduction instead of closed reduction
Define physiological bowing:
3-5: vulgus
0-2: varus
After 5: slight vulgus but normal position
What are the risk factors for pathological varus
- early walkers
- rickets
- infection\tumor\trauma affecting the growth plate
- blounts disease (tibia)
- skeletal dysplasia
In which diseases is bowing affecting the both limbs tibia and femur s
Ricket
&
Skeletal dysplasia
In the blounts disease what is affected?
Only the tibia
Proximal, posterior and medial
What is the sign found in blounts disease in x-ray
The drop sign
What is the deformity in club foot?
- Hind foot: varus & short tendon achilles (equinus)
- mid foot: supination
- Forefoot: adduction
Diff between club foot and DDH in prevalamce
DDH is common in females
What are the possible causes of club foot?
Molding defect or fibrotic contracture or vascular abnormalities s
What is the gold standard treatment club foot (initially)
Manipulation and plaster of paris
Ponsetti casting
At the later stage of ponsetti casting, what do we commonly do?
Lengthining for final correction
What are the alternative therapies if plaster of paris (ponsetti casting failed)
- soft tissue release: 6m
- bony surgery: 5y
What is the commonest organism of septic arthritis
Staph aureus
How does septic arthritis usually develop
After: …..
- direct trauma
- hematogenous spread
- ostemylitis
What are the clinical signs and symptoms of septic arthrtis?
- Pain\tender\swollen joint
- restricted movement
- muscle spasm
- malaise and fever
Why is septic arthritis considered as an emergency
Because you need to drain it immediately to avoid developing it into a sepsis
What other investigations you’d like to see in septic arthitis
- ESR\leukocytosis
- Aspiration analyisis
- US: effusion
- x-ray: joint widening and reaction
- blood culture
What are the 3 diagnostics in septic arthritis
Wbc, glucose, protein
How do we commonly follow up patient with septic arthritis?
CRP (P in 3-4d) and ESR (P 2-3w)
what is kocher criteria?
- WBC
- ESR
- Temp
- weight bear
For septic
Explain numbers in kocher critre
WBC: 12.000 - ESR >40 - T>38.5
What is the gold standard treatment for septic arthritis?
Incisoin and drainage (joint)
+
Systemic anitbiotic (start broad then when identified give specific)
+
Analgesia and bed rest and joint rest (traction, cast, splint)
What are the complications of septic arthritis?
1- septicemia 2- growth plate arrest 3- osteoarthritis 4- joint stiffness 6- AVN(Resorption of femoral head and sublaxation)
Differentiate VOC from acute osteomyelitis:
- 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
What is the gold standard differentiation method for VOC and acute ostemylitis
Bone scan
