Revision - Hip Problems, Rickets & OI Flashcards

1
Q

Clinical features of DDH?

A

1) asymmetrical skin folds

2) leg length discrepancy

3) clunking on special tests

4) limited hip abduction

5) significant bilateral restriction in abduction

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2
Q

What 2 special tests are used to check for DDH?

A

1) Barlow test
2) Ortolani test

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3
Q

What is Barlow vs Ortolani test attempting to do?

A

Barlow –> Gentle downward pressure is placed on knees through femur to see if the femoral head will dislocate posteriorly.

Ortolani –> Gentle pressure is used to abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly

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4
Q

Clicking vs clunking in DDH exam?

A

Clicking - normal

Clunking - more likely to indicate DDH and requires an US

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5
Q

In DDH, if the baby presents <6 months of age, what does 1st line treatment involve?

A

Pavlik harness

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6
Q

What is a Pavlik harness?

A

A soft splint with the aim to hold the femoral head in the correct position to allow the hip socket (acetabulum) to develop a normal shape.

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7
Q

What position does a Pavlik harness keep the baby’s legs in?

A

Abduction & flexion

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8
Q

How long is a Pavlik harness typically on for?

A

6-8w

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9
Q

Management of DDH if the harness fails or the diagnosis is made after 6 months of age?

A

Surgery

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10
Q

What are some red flags for hip pain in children?

A
  • age <3 y/o
  • fever
  • waking at night due to pain (malignancy)
  • weight loss etc
  • stiffness in morning (inflammatory)
  • swollen or red joint
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11
Q

What are the 2 most common organisms causing septic arthritis in children?

A

1) Staph. aureus

2) Strep. pyogenes

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12
Q

What age in children is septic arthritis most common?

A

<4 y/o

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13
Q

What is the most common cause of hip pain in children aged between 3-10 years old?

A

Transient synovitis

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14
Q

How will children with transient synovitis typically hold their leg?

A

In a flexed, abducted and externally rotated position.

This position results in the least amount of intracapsular pressure within the joint and is therefore the least painful.

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15
Q

What movement is limited in transient synovitis?

A

Internal rotation

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16
Q

What special manoeuvre is indicated in transient synovitis?

A

Log roll test

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17
Q

What is the log roll test?

A

Ask the patient to lay supine with the hip and knee extended.

The examiner then passively rotates the entire limb internally and then externally.

A positive test is defined as involuntary muscle guarding when the leg is rolled passively

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18
Q

What is a positive result on a log roll test in transient synovitis?

A

Involuntary muscle guarding when the leg is rolled passively.

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19
Q

When can a working diagnosis of transient synovitis can be managed in primary care?

A
  • afebrile
  • mobile but limping
  • symptoms have been present for <48 hours
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20
Q

What are the 4 aspects of the Kocher criteria?

A

1) non-weight bearing
2) fever >38.5
3) raised WCC
4) raised ESR

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21
Q

3 xray results in septic arthritis?

A

1) joint effusion
2) narrowing of the joint space
3) destruction of the subchondral bone

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22
Q

What is the main complication of Perthes?

A

Early hip osteoarthritis

There is remodelling of the bone as it heals –> causing a soft and deformed femoral head.

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23
Q

What staging system is used in Perthe’s?

A

Catterall staging

24
Q

Describe stage 1 to 4 of the catterall staging

A

Stage 1: clinical and histological features only

Stage 2: sclerosis with or without cystic changes and preservation of the articular surface

Stage 3: loss of structural integrity of the femoral head

Stage 4: loss of acetabular integrity

25
Q

1st line imaging in Perthe’s?

A

XR

26
Q

What movement is typically affected in SUFE?

A

Limited internal rotation in flexion

27
Q

When examining the patient with SUFE, how will they prefer to keep their hip?

A

In external rotation

28
Q

What movement is particularly limited in SUFE?

A

Internal rotation

29
Q

Mx of SUFE?

A

Internal fixation with a cannulated screw placed in the center of the epiphysis

30
Q

What is hereditary hypophosphataemic rickets?

A

A rare form of rickets caused by genetic defects that result in low phosphate in the blood.

31
Q

How is vitamin D created?

A

Created from cholesterol by the skin in response to UV radiation

32
Q

What skeletal deformities may be seen in rickets?

A

1) Craniotabes

2) Frontal bossing

3) Rachitic rosary

4) Bowing deformities e.g. bowlegs (genu varum) or knock-knees (genu valgum)

5) Pectus carinatum (pigeon chest) or pectus excavatum (funnel chest)

33
Q

What is craniotabes?

A

A condition where an infant’s skull bones are soft and thin, causing them to collapse when pressure is applied

34
Q

What is rachitic rosary?

A

Swelling of the ends of the ribs

35
Q

What condition does rachitic rosary indicate?

A

Rickets

36
Q

What serum 25-hydroxyvitamin D establishes a diagnosis of vitamin D deficiency?

A

<25 nmol/L

37
Q

What imaging is required to diagnose rickets?

A

XR

38
Q

Which babies are at higher risk of vitamin D deficiency?

A

Breastfed babies are at higher risk than formula fed babies –> as formula feed is fortified with vitamin D.

39
Q

Prevention of rickets?

A

Breastfeeding women and all children should take a vitamin D supplement: 400 IU (10 micrograms) per day for children and young people.

40
Q

Management of children with vitamin D deficiency?

A

vitamin D (ergocalciferol)

41
Q

What is talipes?

A

A fixed abnormal ankle position that presents at birth.
AKA clubfoot.

42
Q

Is talipes bilateral or unilateral?

A

50% of cases are bilateral

43
Q

What is talipes treated with?

A

The Ponseti method

A way of treating talipes without surgery. It is usually very successful

44
Q

What is the most common type of osteogenesis imperfecta?

A

Type 1 (this is also the mildest)

45
Q

When does osteogenesis imperfecta typically present?

A

In childhood with fractures following minor trauma.

46
Q

Clinical features of osteogenesis imperfecta?

A
  • recurrent and inappropriate fractures
  • hypermobility
  • blue/grey sclera
  • short stature
  • otosclerosis
47
Q

What are the 2 medical treatments involved in the mx of osteogenesis imperfecta?

A

Bisphosphonates & vit D supplementation

48
Q

How are calcium, phosphate, parathyroid hormone and ALP affected in osteogenesis imperfecta?

A

Usually normal

49
Q

What is a rare complication of Osgood-Schlatter disease?

A

A full avulsion fracture.

This is where the tibial tuberosity is separated from the rest of the tibia.

50
Q

What is the most common cause of intestinal obstruction in infants and young children?

A

Intussusception

51
Q

Peak age incidence of intussusception?

A

6m-3y

52
Q

Presentation of mesenteric adenitis?

A

RLQ pain

53
Q

What is the most common cause of chronic diarrhoea in infants in the developed world?

A

Cow’s milk intolerance

54
Q

What is Hirschsprung-associated enterocolitis (HAEC)?

A

Inflammation and obstruction of the intestine occurring in around 20% of neonates with Hirschsprung’s.

This is life threatening as can lead to toxic megacolon and perforation of the bowel.

55
Q

Management of HAEC?

A

Urgent Abx, fluid resuscitation and decompression of the obstructed bowel

56
Q

What is the definitive management of Hirschsprung’s?

A

surgical removal of the aganglionic section of bowel.

57
Q
A