Pediatric Orthopedics Flashcards
What is a sternomastoid tumour
Congenital muscular torticollis
Describe Osgood-Schlatters Disease+ common management
A tibial apophyseal stress lesion, an avulsion of the tibial tubercle due to stress from knee extension, presenting as anterior knee pain with an enlarged tibial tubercle. NSAIDs and activity mod. usually sufficient
How to classify a limping child
Painless: DDH
Painful: Perthes, SCFE, Septic arthritis, Transient synovitis
Risk factors for DDH
Female
First child
Fetal presentation: Breech
FHx
Fluid inflex: Oligohydramnios
Features of DDH
Patient >3/12 old
Limb Length Discrepancy on Galleazzi
Restricted Abduction
Abnormal skin creases
Waddling/Trendelenberg gait
“Packing disorders” a/w DDH
Congenital muscular torticollis
Metatarsus Adductus
Talipes Calcaneovalgus
Mx of DDH
Conservative: Pavlik Harness: Abduct and flex the hip for reduction
Surgical: Open reduction and soft tissue release
Main ddx for limping child in pre,primary and sec sch
Pre: Transient synovitis
Pri: Perthes
Sec: SCFE
What is Perthes disease
Idiopathic avascular necrosis of proximal femoral epiphysis in children resulting in remodelling and deformation of femoral head
Radiologic signs of AVN in children
Increased radiolucency of bone
Most common demographic for Slipped Capital Femoral Epiphysis
Adolescent obese males
Malays at increased risk
PE sign for SCFE
Drehmann sign: Obligatory external rotation on flexion of hip
Radiological lines to look for in SCFE
Klein line and Trethowan sign
Complication that may be caused by grade 3 SCFE
Avascular necrosis
What to suspect in bilateral SCFE
Endocrinopathies: Hypothyroidism, Cushing’s, Gigantism, Obesity
Radiological lines to look for in DDH
Hilgenreiner’s and Shenton’s line
What is Blount’s disease
Progressive Pathological Genu Varum of the knee, centered at Tibia
Causes of Rickets
Nutritional deficiency
Absorption problems?
Renal tubule defects
Common description of club foot
Forefoot adducted
Midfoot cavus
Hindfoot varus
Heel equinus
Mx of club foot
Conservative: Ponseti Casting
Surgical: Percutaneous osteotomy
Scoring for ligamentous laxity
Beighton’s
Ddx for positive Galleazzi in infant
Congenital: DDH, Perthes, SCFE
Traumatic: fx
Cancer: Osteosarcoma
Infection: Septic arthritis
Syndromes: CP,SMA, Polio
Blood supplies to the femoral head
- Medial femoral circumflex(MAIN)
- Ascending branch of lateral circumflex
- Branch of obturator artery
Important things for Hip XR for perthes
- Shenton Line
- Hilgenreiner line
- Perkin line
- Acetabular index
Order of onset of paeds ortho hip condition
DDH earliest, Perthes, SCFE latest
Risk factors for SCFE
- Obesity
- Male
- FHx
- Endocrinopathy
Mx of SCFE
Percutaneously inserted cannulated screw for epiphyseal fixation
Mechanism of SCFE
Slippage at the zone of hypertrophy at the femoral head
Cx of SCFE
- Hip AVN
- Coxa vara
- Femoral acetabular impingement
- Early OA of hip
Presentations of SCFE
- Pain at hip or knee
- Limping child
- Out toeing gait
SCFE findings on PE
- Shortened limb if unilateral
- Obilgatory ext rotation during hip flexion
- Limited int rotation
- Limited int rotation, abduction, flexion
- trendelenburg gait
Lines and findings on Hip XR for SCFE
- Klein’s line
- Trethowan sign: Klein’s line does not intersect the lateral epiphysis
Key Mx of Perthes Disease
Petrie casting and surgical osteotomy
Mx of Congenital Muscular Torticollis
Passive stretching exercises exercises KIV surgical lengthening of SCM (if deformity > 1yr)
Mx of SCFE
Percutaneously inserted cannulated screw
Causes of intoeing gait
- Metatarsus adductus
- Tibial torsion
- Femoral anterversion
