Children's Orthopaedics Flashcards
(50 cards)
1
Q
Which hip problems are more common for children aged between 0-5?
A
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- DDH
- JIA
2
Q
Which hip problems are more common for children aged between 5-10?
A
- Trauma
- Osteomyelitis
- Transient synovitis
- Septic arthritis
- Legg-Calve Perthes disease
3
Q
Which hip problems are more common for children aged between 10-15?
A
- Trauma
- Osteomyelitis
- Septic arthritis
- SUFE
- Chondromalacia
- Neoplasm
4
Q
Which population groups are more likely to have developmental dysplasia of the hip
A
- European populations
- Girls > boys
- First borns
- Birth problems: breech and oligohydramnios (lack of amniotic fluid)
- FH
- Lower limb deformities
5
Q
What are the clinical features of DDH?
A
- Ortolani’s sign (positive if a clunk is heard as the femoral head is abducted and slides over the posterior rim of the acetabulum and is reduced: dislocated)
- Barlow’s sign: examiner attempts to dislocate the femoral head using posterior/lateral pressure
- Piston Motion sign
6
Q
How can DDH be managed?
A
- Casts
- Splinting
- Surgery
7
Q
What is the presentation of Legg-Calve-Perthes disease?
A
- Males > females
- Primary school age
- Short stature
- Limp
- Knee pain on exercise
- Stiff hip joint
- Systemically well
8
Q
Name the phases of LCP
A
- Avascular necrosis
- Fragmentation - revascularisation
- Reossification
- Residual deformity
9
Q
List the unilateral differential diagnoses for LCP
A
- Septic hip
- JIA
- SCFE
- Lymphoma
10
Q
List the bilateral differential diagnoses for LCP
A
- Hypothyroid
- Sickle
- Epiphyseal dysplasia
11
Q
How can LCP be treated?
A
- Maintain hip motion
- Analgesia
- Restrict painful actvities
- Containment - osteotomy
12
Q
What is the presentation of SUFE/SCFE (slipped capital femoral epiphysis)?
A
- Teenage boys > girls (9-14 yrs)
- Pain in hip or knee
- External posture and gait
- Reduced internal rotation, especially in flexion
13
Q
How is SUFE/SCFE classified?
A
- Acute vs chronic (3 weeks)
- Stable vs unstable
14
Q
How can SUFE/SCFE be treated?
A
-Surgery
15
Q
What are the potential consequences of SCFE/SUFE?
A
- AVN
- Chondrolysis
- Deformity
- Early osteoarthritis
16
Q
Name the five most common causes of limp in children
A
- Toxic synovitis
- Septic arthritis
- Trauma
- Osteomyelitis
- Viral syndromes
17
Q
What is the most common site of origin for a limp in children?
A
Hip
18
Q
What are the causes of limp in children aged 0-5 yrs?
A
- Normal variant
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- DDH
- JIA
19
Q
What are the causes of limp in children aged 5-10yrs?
A
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- Perthes
20
Q
What are the causes of limp in children aged 10-15yrs?
A
- Trauma
- Osteomyelitis
- Septic arthritis
- SUFE
- Chondromalacia
- Neoplasm
21
Q
Which features on a history would make an infection more likely?
A
- Limp
- Pain
- Malaise/loss of appetite/listless
- Temperature
- Recent URTI/ear infections
- Trauma
- Pseudoparalysis
22
Q
What initial investigations would you do if you suspected an infection?
A
- Temperature
- X-ray or USS
- Bloods: WCC, CRP, ESR, CK and cultures
23
Q
How does septic arthritis present?
A
- Limping
- Pseudoparalysis
- Swollen, red joint
- Refusal to move joint
- Pain
- Temperature
24
Q
Name the top 3 common sites for septic arthritis
A
- Knee
- Hip
- Ankle
25
What investigations should be done for septic arthritis?
- FBC, ESR, CRP and cultures
- X-ray
- USS
- Synovial fluid: WCC, gram stain and culture
26
What are the Kocher criteria for septic arthritis?
- Pyrexia
- Non weight bearing
- WBC > 12,000/ml
- ESR > 40mm/hr
27
What is the treatment of septic arthritis?
- Aspiration
- Arthroscopy
- Arthrotomy
- Antibiotics (2 weeks IV and 6 weeks in total)
28
How does osteomyelitis present?
- Pain
- Localised signs and symptoms
- Fever
- Reduced range of movement
- Reduced weight bearing
29
What initial investigations should be done for osteomyelitis?
- X ray
- CRP
- ESR
- WCC
- Blood culture
30
What are the indications for surgery in osteomyelitis?
- Aspiration for culture
- Drainage of subperiosteal abscess
- Drainage of joint sepsis
- Debridement of dead tissue
- Failure to improve
- Biopsy in equivocal cases
31
What are the features of transient synovitis?
- Limping, often touch weight bearing
- Slightly unwell
- History of viral infection
- Apyrexial
- Low CRP, normal WCC
- May have joint infusion
32
Which features raise a concern of cancer?
- Night pain
- Incidental trauma
- Stops doing sport/going out
- Sweats and fatigue
- Abnormal blood results: low haemaglobin, atypical blood film and atypical platelets
33
What is a galeazzi fracture?
a fracture of the distal third of the radius with dislocation of the distal radioulnar joint
34
What is a monteggia fracture?
a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius
35
What should be assessed when a child presents with a bone fracture?
- History: mechanism
- Deformity
- Soft tissue: wounds, sensation, motor function and vascular status
36
What are the indications for surgery for a fracture?
- <9yrs: >15 angulation and >45 malrotation
- >9 yrs: proximal >10 angulation and >30 malrotation and distal >15 angulation
- Open fracture
- Segmental
- NV compromise
- Failed closed
37
What are the principles of closed management?
- Analgesia
- Reduce: disimpact and bend force over apex
- Molded cast 4-6 weeks
- Restrict activity for 3-4 months
38
What are the complications of radial fractures?
- Compartment surgery
- Radioulnar synostasis
- PIN injury
- Superficial radial nerve injury
- DRUJ/radiocapitellar problems
39
How can distal radial fractures be managed?
- Buckle: cast for 3-4 weeks
- Greenstick: cast for 4-6 weeks
- Complete: cast +/- K wires 6 weeks
40
What are the risks for remanipulation in distal radial fractures?
- Complete fractures
| - Failed autonomic reduction
41
What are the differential diagnoses for knee trauma?
- Infection
- Inflammatory arthropathy
- Neoplasm
- Apophysitis
- Hip or foot
- Sickle haemophilia
42
What are the causes of physeal injury and how can they be treated?
- Hyperextension and varus - CPN injury
- Cast, percutaneous fix, ORIF articular displacement and
- Range of motion early
43
What are the different types of tibial spine injuries?
- I: undisplaced
- II: hinged
- III: displaced
44
How can tibial spine injuries be treated?
- I/II: long leg cast
| - II/III: ORIF/AxIF
45
How can patellar fractures be treated?
- Undisplaced: cylinder cast
| - Displaced: ORIF
46
What are the risk factors for patellar dislocation?
- Laxity
- Poor VMO
- Q angle
- Femoral anteversion
- Tibial external rotation
- Patella alta
47
How can patellar dislocations be managed?
- Cast for two weems
- Mobilise
- VMO exercises
48
What is Osgood-Schlatter's disease?
Inflammation of the patellar ligament at the tibial tuberosity (apophysitis)
49
What is Sever's disease
Swelling and irritation of the growth plate in the heel
50
What are the warnings of a potential NAI?
- Incongruent history
- Pattern of bruising
- Burns
- Multiple fractures in multiple stages of healing
- Metaphyseal and humeral shaft fractures
- Rib fractures
- Non ambulant fractures
