Paeds - MSK Flashcards
What is Perthes Disease?
What is difference in uptake of femoral head in early vs late?
Avascular necrosis of the femoral head
Usually 4 - 8 year olds (5x more common in boys)
‘Painful limp’
Key Features
Small flat ossified femoral epiphysis
Sclerosis of femoral epiphysis
Widening of joint space due to effusion
Radiolucent crescent line (sign of a fracture)
Early: wide joint space, small femoral epiphysis, sclerosis femoral head. (LOW UPTAKE IN FEMORAL HEAD ON NUCLEAR SCAN)
Late: subchondral fracture (radiolucent sign), femoral head fragmentation, femoral neck cysts
(HIGH UPTAKE IN FEMORAL HEAD ON NUCLEAR SCAN)
Best appreciated on Frog leg view
Perthes vs SUFE
Septic arthritis in a kid
What would you see on US?
What is most common pathogen in neonate?
Emergency
Will see joint effusion with possible debris present within
-Joint effusion may show as lateral displacement of femoral head on XR
Commonest pathogen in neonate is Gp B strep
Apophyseal injuries
What muscles attach to ASIS and AIIS?
ASIS - sartorius
AIIS - Rectus femoris
What is a Monteggia fracture?
What is Galeazzi?
Monteggia - FOOSH injury
Causing ulnar fracture and radial head dislocation
Galeazzi - Radial fracture with dislocation of the distal radioulnar joint
GRUesome MURder
What is a Fibrous cortical defect?
Appear in children 4 - 7 years
Heal by adulthood
Asymptommatic cortical defect
Oval in shape and extend along long axis of bone
Sclerotic margin
(similar to non-ossifying fibroma however they extend over larger area and are in older patients)
What is Fibrous dysplasia?
Benign developmental condition
Lesions can be symptommatic with swelling and pain
- -Medullary based and lucent*
- -Ground glass matrix*
- -Well defined sclerotic margin*
- -Can cause expansion*
Mono-ostotic or polyostotic
(Most common mono-ostotic is expanile lesion in the ribs)
(Polyostotic still tends to be restricted to just 1 limb)
Fibrous Dysplasia - Shepherds Crook
Fibrous dysplasia lesion
What is a Glomus tumour?
Benign vascular tumours of the soft tissue under the fingernail
Appears as a blue or red nodule
Hildreth sign = if pain relieved by putting on tournequet proximal to it
CRITOL
Salter Harris
Downs associations?
Atlantoaxial subluxation
Odontoid PEG abnormalities
What findings does mucopolysaccharidosis give?
Anterior beaking of the vertebral bodies
- Short wide metacarpals
- Shortening of long bones
- Macrocephaly
- Oar shaped ribs
What is Homocystinuria?
Defect in collagen and elastin
Can get fractures
- metaphyseal cupping
- delayed ossification
- can be tall
Downward dislocation of lens
What is Madelung deformity?
Bowing of radial shaft
Short 3rd and 4th metacarpals (ONLY IN TURNERS)
Increased interosseous space
Dorsal subluxation of radioulnar joint
Assocaited with:
- Turners (has short 3rd/4th metacarpals)
- Nail patella
What is Scheuermans disease?
Adolescent kyphosis
Onset at puberty
Abrupt angulation at mid to lower thoracic region
- Disc space narrowing
- Endplate irregularities
- Kyphosis
What is alpha angle of the hip measured from?
What is angle in DDH?
Congenital dislocation of the hip
Angle between straight lateral edge or ileum and bony acetabular margin
- ≥60°: normal
- <60°
- >12 weeks old: acetabular dysplasia
- 0-12 weeks old: could represent a physiologically immature hip that could go on to mature without treatment
If hip is actually dislocated - angle will be less than 43 degrees
In a Neonate aged 2 weeks with positive ortolani and barlows it is too early to perform hip US
Hip US should be performed after 1 month
SUFE
In what direction is the femoral is the physis displaced?
Where does ‘line of klein’ usually intersect?
Displaced posteromedially in relation to the femoral neck
Line of Klein usually intersects the femoral head
In SUFE line of klein will not intersect femoral head
AP and Frog leg view required
