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Year 4 Paediatrics > Paediatric Orthopaedics > Flashcards

Paediatric Orthopaedics Flashcards

1
Q

Pain medication in children

A

Codeine and tramadol are not used in children as they are unpredicatble in their metabolism

Aspirin is not used in children younger than 16 yo due to Reye’s syndrome

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2
Q

Differentials for a limp

A

0 - 4 years:

  • Transient synovitis
  • Septic arthritis
  • Developmental dysplasia of the hip

5 - 10 years

  • Perthe’s disease
  • Transient synovitis

10 - 16 yo

  • Juvenile idiopathic arthritis
  • Slipper upper femoral epiphysis
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3
Q

Presentation of hip pain

A 
Limp 
Not bearing weight on affected side 
Delayed walking 
Pain 
Swollen and tender joint
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4
Q

Red flags for hip pain

A 
Children under 3 yo 
Fever 
Waking at night with pain 
Weight loss and anorexia 
Night sweats
Fatigue 
Persistent pain 
Stiffness in the morning 
Swollen or red joint
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5
Q

When to urgently refer a limping child

A 
Children under 3 yo 
Child > 9 yo with a restricted or painful hip 
Unable to weight bear 
Neurovascular compromise 
Severe pain 
Suspicion of abuse
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6
Q

Investigations for hip pain

A 
Bloods - CRP, FBC
Xray - fracture, SUFE
USS - effusion 
Joint aspiration - sepsis 
MRI - osteomyelitis
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7
Q

Causative organisms for septic arthritis

A 
Staphylococcus aureus - most common 
Neiserris gonorrhoea 
Streptococcus pyogenes 
Haemophilus influenzae 
E. Coli
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8
Q

Management of septic arthritis

A

Antibiotics dependent on joint aspirate culture for 3 - 6 weeks

Surgicsl drainage and washout

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9
Q

Transient synovitis pathophysiology

A

Inflammation of the synovial membrane associated with a recent viral upper respiratory tract infection

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10
Q

What age range does transients synovitis typically affect

A

3 - 10 yo

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11
Q

Presentation of transient synovitis

A
  • after viral URTI - coryzal symptoms
  • limp
  • refusal to weight bear
  • joint pain
  • low fever
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12
Q

Management of transient synovitis

A

Exclude septic arthritis
Symptomatic relief - analgesia

Can be managed in primary care if 3 - 9yo and limp present within 48 hours whilst systemically well

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13
Q

Prognosis of transient synovitis

A

Significant improvement after 24 - 48 hours

Symptoms fully resolve within 1 - 2 weeks without any lasting problems

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14
Q

Perthes disease pathophysiology

A

Avascular necrosis of the femoral head

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15
Q

Who does perthes disease typically affect?

A

Children aged 4 - 12 yo

Commonly between 5 - 8 yo boys

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16
Q

Complication of perthes disease

A

Early osteoarthritis of the the hip

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17
Q

Presentation of perthes disease

A

Pain in the hip or groin
Limp
Restricted hip movements
Referred pain to the knee

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18
Q

Investigations for perthes disease

A

Bloods - normal
Technetium bone scan
MRI scan

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19
Q

Management of Perthes disease

A

Under 6 yo mild to moderate disease - supportive:

  • bed rest and analgesia
  • traction
  • crutches
  • physiotherapy
  • regular xrays - monitoring

Severe disease > 6yo - surgery

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20
Q

Slipper upper femoral epiphysis pathophysiology

A

Head of the femur is dispaced along the growth plate

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21
Q

Who does SUFE typically affect

A

Obese boys aged 8 - 15yo

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22
Q

Presentation of SUFE

A
  • hip, groin, thigh or knee pain
  • restricted hip movement - inability to internally rotate
  • painful limp
23
Q

Investigations for SUFE

A

Bloods - usually normal
Technetium bone scan
CT scan
MRI scan

24
Q

Management of SUFE

A

Surgery - cannulated screws

25
Q

Pathophysiology of osteomyelitis

A

Infection of the bone or bone marrow

26
Q

Causative organism of osteomyelitis

A

Staphylococcus aureus

27
Q

Risk factors for osteomyelitis

A
  • open bone fracture
  • orthopaedic surgery
  • immunocompromised
  • sickle cell anaemia - salmonella
  • HIV
  • TB
28
Q

Presentation of osteomyelitis

A 
Painful limp 
Refusal to weight bear 
Pain 
Swelling 
Tenderness 
May have fever if acute
29
Q

Investigations for osteomyelitis

A 
Joint xray - may be normal
MRI - gold standard 
Bone scan 
Bloods - FBC, CRP
Blood culture 
Bone marrow aspiration or bone biopsy
30
Q

Management of osteomyelitis

A

Antibiotics - flucloxacillin

Surgical drainage and debridement

31
Q

Features of osteosarcoma

A
  • typically affects 10 - 20 yo

- commonly affects the femur, tibia and humerus

32
Q

Presentation of osteosarcoma

A

Persistent bone pain
Particularly worse at night
Bone swelling - palpable mass
Restricted joint movements

33
Q

Investigations for osteosarcoma

A
  • urgent direct access xray within 48 hours of unexplained bone pain or swelling
  • bloods - ALP
  • Staging CT scan
  • PET or bone scan
  • Bone biopsy
34
Q

Signs of osteosarcoma on xray

A

Sun burst appearance - fluffy due to periosteal reaction

35
Q

Management of osteosarcoma

A

Surgical resection
Adjuvant chemotherapy
MDT

36
Q

Developmental hip dysplasia pathophysiology

A

Structural abnormality of the hips causing instability and an increased tendency to sublux or dislocate as well as an abnormal gait and weakness

37
Q

Risk factors for developmental hip dysplasia

A
  • Family history
  • breech presentation
  • multiple pregancy
38
Q

DDH screening

A

USS scan of hip if risk factors present

Neonatal exam - ortalani and barlow tests

39
Q

Signs of DDH

A

Different leg lengths
Restricted hip abduction either unilateral or bilateral
Difference in knee level when hips are flexed
Clunking during the Ortolani and Barlow test

40
Q

Ortolani test

A

Dislocate anteriorly whilst hips and knees are flexed by abducting

41
Q

Barlow test

A

Whilst hips are adducted and flexed at 90 degrees. Gentle downwards pressure to see if hip dislocates posteriorly

42
Q

Investigation for DDH

A

USS of hip

43
Q

Management of DDH

A

Pavlik harness for 6 - 8 weeks - < 6 months yo

Surgery if > 6 months with hip spica cast

44
Q

Pathophysiology of rickets

A

Defective bone mineralisation causing soft bones due to a vitamin D or calcium deficiency

Calcium deficiency stimulates parathyroid hormone which stimulates bone resorption

45
Q

Presentation of rickets

A 
Lethargy 
Bone pain 
Swollen wrists
Bone deformity 
Poor growth 
Dental problems 
Pathological fractures
46
Q

Bone deformities in rickets

A

Bowing of the legs - valgus deformity

Knock knees - varus deformity

Rachitic rosary - lumps along the chest where ribs expand at the costochondral junctions

Craniotabes - soft skull, frontal bossing and delayed closure of the sutures

Delayed teeth

47
Q

Risk factors for rickets

A 
Darker skin 
Low exposure to sun light - muslim women 
Live in colder climates 
Indoors 
CKD
48
Q

Investigations of rickets

A

Bloods - vitamin D, calcium, PTH, ALP, phosphate, FBC, CRP, LFTs, U+Es, TFTs

Anti TTG - coeliacs (malabsorption)

Autoimmune and rheumatoid tests

Xray

49
Q

Management of rickets

A

Vitamin D and calcium supplements

50
Q

Osgood schlatters disease pathophysiology

A

Inflammation of the tibial tuberosity where the patella ligament inserts due to multiple small avulsion fractures

51
Q

Who typically gets Osgood schlatters disease

A

10 - 15 year old boys

52
Q

Presentation of Osgood Schlatters disease

A

Normally unilateral anterior knee pain
Pain exacerbated by activity
Visible lump below the knee - hard and non tender (initially may be tender)

53
Q

Managament of Osgood schlatters

A
  • reduce physical activity
  • RICE
  • NSAIDs

Stretching and physiotherapy

Year 4 Paediatrics (19 decks)

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