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My MSK flashcards > Week 3 Paediatrics - Hip, Knee, Foot and Spine > Flashcards

Week 3 Paediatrics - Hip, Knee, Foot and Spine Flashcards

1
Q

which hip is most commonly affected by DDH?

what gender?

A

the left one

80% girls

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2
Q

what happens to the hip if DDH is untreated?

A

“False acetabulum” forms proximal to the original, leading to the leg being shorter

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3
Q

what is the Ortolani test?

A

For DDH - pulling a dislocated hip back into place

ABDUCTION AND ANTERIOR DISPLACEMENT

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4
Q

what is the barlow test?

A

Dislocating the hip with FLEXION AND POSTERIOR DISPLACEMENT

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5
Q

In early DDH, what is the preferred method of imaging?

  • CT
  • US
  • MRI
  • X ray
A

ultrasound in early stages

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6
Q

what is the preferred method of imaging for DDH once baby is older?#

  • CT
  • MRI
  • US
  • Xray
A

x ray

cant be used until ossification at 4-6 months though

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7
Q

describe treatment of DDH

  • equipment
  • duration
  • success rate?
A
  • Pavlik harness
  • full time 6 weeks,
  • part time 6 weeks
  • up to 95%
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8
Q

is Fredrick the 18 month old DDH baby able to use the Pavlik harness?

A

No (must be under 4-6 months)

F will require open reduction surgery

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9
Q

what causes transient synovitis of the hip?

A

Normally a viral URTI

sometimes idiopathic

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10
Q

who is affected by transient synovitis of the hip?

A

Boys > girls

Age 2-10 years

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11
Q

most common cause of hip pain in children?

A

transient synovitis

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12
Q

what pathologies do you need to consider in children presenting with hip pain? (5)

A 
Septic arthritis
Perthes disease
Juvenile idiopathic arthritis
RA
Transient synovitis of the hip
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13
Q

what would tell you that it is transient synovitis of hip rather than septic arthritis?

A 
Pain - not as severe
Motion - not as restricted
Fever - low grade
Systemically - not unwell
CRP - normal
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14
Q

Treatment of transient synovitis? is it…

  • antibiotics
  • nothing
  • NSAIDs
A

its c = NSAIDS and rest

(normally a viral cause not bacterial)

assess again if not improving

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15
Q

what causes the abnormal growth in perthes?

A
  1. Transient loss of blood supply
  2. necrosis
  3. remodelling
  4. abnormal shaped bone
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16
Q

Does late age of onset affect severity of Perthes?

A

YES = Late onset is worse

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17
Q

how does Perthes typically present?

  • age
  • gender
  • appearance
  • symptoms
A

Age 4-9
Boys
Active and short in height
Pain AND LIMPING

18
Q

why is a bilateral case of Perthes worrying??

A

Should be unilateral

This suggests either Skeletal dysplasia or Thrombophilia (increased clotting)

19
Q

Most important hip examination for early Perthes? (1)

A

Internal rotation!!! (lost)

20
Q

3 hip tests for Perthes

A
  1. internal rotation
  2. abduction
  3. positive Trendellenburg
21
Q

What 3 things may predispose to SUFE?

  • weight problem
  • thyroid problem
  • organ problem
A

OVERWEIGHT

HYPOthyroid

RENAL DISEASE

22
Q

Treatment of SUFE?

A

Urgent surgery - pin the femoral head to prevent more slippage

23
Q

what are “Extensor Mechanism” problems?

A

Strain injury due to increasing body weight in teenagers and more sports

24
Q

What are the 3 subtypes of Extensor mechanism problems

A
  1. Patellar tendonitis (jumper’s knee)
  2. Osgood schlatters
  3. Sinding-Larsen-Johanssen
25
Q

name the 2 Apophysitises (inflamed growing tubercle attatchment)

A
  1. Osgood

2. Sinding Larsen Johanssen

26
Q

What does sinding Larsen johanssen affect?

A

The inferior pole of the patella

27
Q

What is Chondromalacia Patellae ?

A

softening of the patella cartilage which may occur with anterior knee pain

28
Q

what problem with the femur could lead to patellar instability?

A

Shallow femoral trochlea

29
Q

what % of patella dislocations have another?

A

20% with one

10% have multiple

30
Q

common meniscal tears in young people?

A

Peripheral

Bucket handle

31
Q

Joints affected by Club foot?

A

the ones between these 3 foot bones

  • talus
  • calcaneus
  • navicular
32
Q

Pathology of club foot

A
  • Abnormal foot joint alignment

- Soft tissues around them contract (ligaments, tendons)

33
Q

what is a risk factor for club foot?

  • not enough amniotic fluid
  • too much amniotic fluid
  • abnormal amniotic fluid
A

Not enough = oligohydramnios

34
Q

What is used after the ponsetii technique??

A

80% need an achilles tenotomy

35
Q

True or False: Hallux Valgus

  • Sporadic
  • occurs in adults only
  • surgery recommended
A

False - normally strong FMH

Late teens is common

Early surgical correction often leads to recurrence

36
Q

how do you investigate a painful scoliosis??

A

MRI for tumour / infection

37
Q

What organ can be affected by severe scoliosis? Solution??

A

lungs = restrictive lung defect

Surgery is used to help

38
Q

2 causes of spondylolisthesis?

A
  1. developmental defect
  2. recurrent spinal stress fractures

leads to 1 vert slipping over another

39
Q

signs of spondylothesis?

A

pain
radiculopathy
Flat back
waddling gait (if acute)

40
Q

what causes a “flat back” presentation?

A

Muscle spasm in Spondylolithesis

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