Pediatrics Flashcards
Discuss the differential for a limping child
Neurologic:
- cerebral palsy
- peripheral neuropathy
- infection: meningitis, epidural abscess
- complex regional pain syndrome
- neoplastic
Abdominal:
- infection: appendicitis, PID, abscess
Bone Pathology:
- Vascular: Legg-Calves-Perthes disease, sickle cell crisis
- Infection: osteomyelitis
- Trauma: fractures, SCFE
- Neoplastic
Joint Pathology:
- Vascular: osteochondritis dissecans
- Infection: septic arthritis, Lyme disease
- trauma: hemarthrosis
- autoimmune/inflammatory: SLE, JIA, transient synovitis
- congenital: DDH
Soft tissue:
- Infection: myositis, cellulitis, necrotizing fasciitis
- trauma: muscle strain, ligament sprain, hematoma
- inflammatory: tendinitis, bursitis
Discuss the different forms of pathological gait conditions
Antalgic gait: short stance phase due to pain with weightbearing
Trendelenburg gait: downward pelvic tilt on swing phase of the contralateral hip (DDH, LCPD, SCFE)
Stoppage gait: foot drop with exaggerated hip and knee flexion during swing phase
Toe-walking gait: walking on toes due to heel pain or tight heel cords
Vaulting gait: hyper-extended knee and locked at the end of stance phase (limb length discrepency)
Stooping gait: shuffling with hip fixed due to abdominal pathology
What are the Kocher criteria and what does it correlate with?
Criteria (1 point each):
- non-weightbearing on affected side
- ESR >40
- fever >38.5
- WBC >12
Kocher >2 have 40% risk of septic arthritis, >3 have 93% risk
Discuss the complications with a Salter-Harris fracture
Result in premature closure of the growth plate or interference with symmetric growth resulting in angular deformity, limb length discrepancy, or joint incongruity
Greatest risk of with Salter Harris 3 and 4 as have disruption of the proliferative and reserve zones, require ORIF
Discuss the mechanism and presentation of a green stick fracture
Mechanism: bone is bent and convex/tensile side of bone fails
Presentation: fracture on convex side that does not continue to concave side with associated angular/plastic deformity of the bone
Management: bend bone to straighten, usually fractures concave side, in order to reduce
Discuss the mechanism and presentation of a torus fracture
Buckle fracture
Mechanism: compression at junction of metaphysis and diaphysis
Presentation: buckling of bone on either side without displacement or angulation
Management: immobilization for 3-4 weeks
Discuss the mechanism and presentation of spiral fractures
Mechanism: rotational force at low velocity
Presentation: fracture line spirals around bone
Management: reverse rotational injury and immobilize
Discuss the mechanism and presentation of an oblique fracture
Mechanism: diagonal forces acting on bone
Presentation: fracture line travels obliquely across bone
Management: reduction
Discuss the mechanism and presentation of a transverse fracture
Mechanism: 3 point bending fracture
Presentation: fracture line is transverse across bone
Management: closed or open reduction
What are the risk factors for developmental dysplasia of the hip
- Family history
- Breech positioning
- First born
- Female
What are the four types of DDH
Unstable hip
- femoral head is reduced but can be dislocated
Acetabular dysplasia
- shallow acetabulum with varying degree of normality of the femoral head
Subluxated Hip
- femoral head contacts only portion of acetabulum
Dislocated Hip
- femoral head does not articulate with any portion of acetabulum
What is the examination and investigation for DDH
Ortolani: Reducing hip
Barlow: Dislocating hip
Galeazzi: limb length discrepency when flexed to 90 degrees
Limitation to hip abduction when >3 months
Ultrasound: from birth to 4 months
X-ray from 4-6 months
- Hilgenreiner’s line (ossification inferior to line)
- Perkin’s line (ossification medial to this line)
- Shenton’s line (continuous line)
- Acetabular index (<25 degrees in >6 months)
- Centre edge angle (> 20 degrees in older >5)
Management:
- Pavlik harness beginning if less than 6 months
- Closed reduction if between 6-18 months
- Open reduction if >18 months
Discuss the presentation and management of osteomyelitis
Pathophysiology - have hematogenous spread of bacteria that get stuck in the spiral arteries along the metaphysis - staph aureus - salmonella typhi in sickle cell Presentation - localized extremity pain with associated skin erythema and swelling - fever Investigations - CBC, ESR, CRP - MRI Management - Require IV Ancef until CRP decreases by half and then PO for 4 weeks.
Discuss the presentation and management of SCFE
- type 1 salter harris injury
- occur during pubertal growth
Risk Factors - male
- obese
- hypothyroid
Presentation - sudden severe ipsilateral hip pain in acute setting
- limp with ipsilateal knee pain
- restricted ROM to internal rotation, abduction and flexion
- obligate external rotation of the hip with flexion
Investigation - X-ray show disruption of Klein line
Management - ORIF
