Week 3 Paediatrics - Hip, Knee, Foot and Spine Flashcards
which hip is most commonly affected by DDH?
what gender?
the left one
80% girls
what happens to the hip if DDH is untreated?
“False acetabulum” forms proximal to the original, leading to the leg being shorter
what is the Ortolani test?
For DDH - pulling a dislocated hip back into place
ABDUCTION AND ANTERIOR DISPLACEMENT
what is the barlow test?
Dislocating the hip with FLEXION AND POSTERIOR DISPLACEMENT
In early DDH, what is the preferred method of imaging?
- CT
- US
- MRI
- X ray
ultrasound in early stages
what is the preferred method of imaging for DDH once baby is older?#
- CT
- MRI
- US
- Xray
x ray
cant be used until ossification at 4-6 months though
describe treatment of DDH
- equipment
- duration
- success rate?
- Pavlik harness
- full time 6 weeks,
- part time 6 weeks
- up to 95%
is Fredrick the 18 month old DDH baby able to use the Pavlik harness?
No (must be under 4-6 months)
F will require open reduction surgery
what causes transient synovitis of the hip?
Normally a viral URTI
sometimes idiopathic
who is affected by transient synovitis of the hip?
Boys > girls
Age 2-10 years
most common cause of hip pain in children?
transient synovitis
what pathologies do you need to consider in children presenting with hip pain? (5)
Septic arthritis Perthes disease Juvenile idiopathic arthritis RA Transient synovitis of the hip
what would tell you that it is transient synovitis of hip rather than septic arthritis?
Pain - not as severe Motion - not as restricted Fever - low grade Systemically - not unwell CRP - normal
Treatment of transient synovitis? is it…
- antibiotics
- nothing
- NSAIDs
its c = NSAIDS and rest
(normally a viral cause not bacterial)
assess again if not improving
what causes the abnormal growth in perthes?
- Transient loss of blood supply
- necrosis
- remodelling
- abnormal shaped bone
Does late age of onset affect severity of Perthes?
YES = Late onset is worse
how does Perthes typically present?
- age
- gender
- appearance
- symptoms
Age 4-9
Boys
Active and short in height
Pain AND LIMPING
why is a bilateral case of Perthes worrying??
Should be unilateral
This suggests either Skeletal dysplasia or Thrombophilia (increased clotting)
Most important hip examination for early Perthes? (1)
Internal rotation!!! (lost)
3 hip tests for Perthes
- internal rotation
- abduction
- positive Trendellenburg
What 3 things may predispose to SUFE?
- weight problem
- thyroid problem
- organ problem
OVERWEIGHT
HYPOthyroid
RENAL DISEASE
Treatment of SUFE?
Urgent surgery - pin the femoral head to prevent more slippage
what are “Extensor Mechanism” problems?
Strain injury due to increasing body weight in teenagers and more sports
What are the 3 subtypes of Extensor mechanism problems
- Patellar tendonitis (jumper’s knee)
- Osgood schlatters
- Sinding-Larsen-Johanssen
name the 2 Apophysitises (inflamed growing tubercle attatchment)
- Osgood
2. Sinding Larsen Johanssen
What does sinding Larsen johanssen affect?
The inferior pole of the patella
What is Chondromalacia Patellae ?
softening of the patella cartilage which may occur with anterior knee pain
what problem with the femur could lead to patellar instability?
Shallow femoral trochlea
what % of patella dislocations have another?
20% with one
10% have multiple
common meniscal tears in young people?
Peripheral
Bucket handle
Joints affected by Club foot?
the ones between these 3 foot bones
- talus
- calcaneus
- navicular
Pathology of club foot
- Abnormal foot joint alignment
- Soft tissues around them contract (ligaments, tendons)
what is a risk factor for club foot?
- not enough amniotic fluid
- too much amniotic fluid
- abnormal amniotic fluid
Not enough = oligohydramnios
What is used after the ponsetii technique??
80% need an achilles tenotomy
True or False: Hallux Valgus
- Sporadic
- occurs in adults only
- surgery recommended
False - normally strong FMH
Late teens is common
Early surgical correction often leads to recurrence
how do you investigate a painful scoliosis??
MRI for tumour / infection
What organ can be affected by severe scoliosis? Solution??
lungs = restrictive lung defect
Surgery is used to help
2 causes of spondylolisthesis?
- developmental defect
- recurrent spinal stress fractures
leads to 1 vert slipping over another
signs of spondylothesis?
pain
radiculopathy
Flat back
waddling gait (if acute)
what causes a “flat back” presentation?
Muscle spasm in Spondylolithesis
