pedmsk

Question 1

Slipped Capital Femoral Epiphysis (SCFE)

risk factors

what to do if suspect

Answer 1

upper femoral epiphysis slips posteriorly from its functional position in the hip resulting in weakness of growth plate (physis)

Result: displacement allows gradual slippage and epiphysis is at risk for avascular necrosis

Most common adolescent hip disorder Usually develops during periods of accelerated growth (8-15 yrs) – peaks at pubertal growth spurt Etiology unknown: multifactorial- genetic (autosomal dominant), endocrine component Mechanism often sport injury/trauma or falls 

Risk factors: 3:1 more common in males; obesity; African American; hypothyroid,

obese pts can have referred knee pain

SCFE is an EMERGENCY - to ER

Question 2

FFABER

refers to?

what organisms

order what?

do what?

seen in what age?

Answer 2

Flexed
Febrile
ABduction
External Rotation

Septic Hip/arthritis

usually staph or strep

order cbcdif, CRP, ESR, blood cultures
xray
u/s of hip - joint effusion

send to ER

50% seen in kids under 2 y.o cuz prevelance of infection

Question 3

Transient Synovitis of hip

Answer 3

Symptoms:
Unilateral hip pain with movement 
Sometimes referred knee or thigh pain
Difficulty walking/refusal to walk
Limping
Night crying
Low grade fever or afebrile
Recent history of URI and others otitis, pharyngitis, GI

Acute inflammatory condition of inner lining of the hip and synovium within joint capsule
Most common cause of acute hip pain in young children between 3-10yrs
2:1 boys to girls
Cause: thought to be post viral syndrome; trauma also thought to be contributing factors… however, true cause is non-definitive
Duration: few days

Question 4

Septic Hip versus Transient/Toxic Synovitis?

Answer 4

Kocher Criteria
Fever (temp > or = 38.5C)
Unable to bear weight
WBC> 12.0 x 10(9) cells/L
ESR> or = 40 mm/hr (norm = 3-13)
CRP> or = 2.0 mg/dL (norm = or <1)
* NPV with 0 criteria is close to 100%
* Only helpful with septic hip, not other joints

log roll test - transient

Question 5

toddles fracture

Answer 5

On exam: refuses to bear weight
Normal or point tenderness
Naturally corrects by 10-12 years
Diagnostics:
x-rays, bone scan
Treatment: casting in ER, ortho follow-up

no systemic s/s

Question 6

perthes disease

Answer 6

interrupt vascular supply to prox femur and growth plate = bone necrosis

persistent pain, limp

Question 7

genu varum

genu valgum

Answer 7

bows legs, normal until 2, refer if > 3 years

knocked knees, normal til 6 years, refer >6

Question 8

Talipes Equinovarus (“Club Foot”)

Answer 8

3 elements:

1. Foot in pointed toe position
2. Sole of foot is inverted
3. Forefoot has convex shape of metatarsus adductus

• The foot CANNOT be manually corrected to neutral position with the heel down
  refer to ortho

Question 9

growing pains

Answer 9

Deep extremity pain
Usually lower extremities 
Usually bilateral
Rarely involves joints
Worse at night; resolves in am
2-5 yr or 8-12 yr
AFEBRILE!!!
Diagnosis is significant for lack of S&S
Treat with heat, massage

Question 10

clavicle fracture

Answer 10

One of most commonly fractured bone in children
neurovascular injury is rare
orthopedic consultation is rarely required
teach parents about “the lump” - normal, superficial, will reabsorb

Question 11

red flags back pain

Answer 11

Any child with structural lateral curvature of the spine
Paresthesia and or paralysis
Loss in bladder/bowel control after being continent
Excruciating flank pain radiating to the genitalia
Inability to do straight leg lift