Orthopaedics

Question 1

most common cause of hip pain in children

Answer 1

transient synovitis

- temporary inflammation of the synovial membrane

Question 2

what precedes transient synovitis

Answer 2

URTI

Question 3

presentation of transient synovitis

Answer 3

hip pain/limp/refusal to weight bear in context of viral illness
child otherwise well – no fever, this would suggest septic arthritis

management is symptomatic

Question 4

what is septic arthritis?

what is the most common cause?

Answer 4

infection inside a joint

most commonly caused by staph. aureus

Question 5

presentation of septic arthritis

Answer 5

acute onset red, swollen, hot, painful joint
limited range of movement
fever

Question 6

ix of septic arthritis

Answer 6

joint aspiration

- ABX given once causative organism confirmed

Question 7

what is Perthes disease

Answer 7

avascular necrosis of femoral head

Question 8

who typically gets Perthes disease

Answer 8

boys age 5-8 years

Question 9

presentation of Perthes

Answer 9

slow onset pain in hip/groin
may have referred pain to knee
restricted movements

Question 10

ix of Perthes

Answer 10

XRAY

Question 11

management of Perthes

Answer 11

bed rest + limit physical activity
analgesia
regular XRAYS

Question 12

what is a SUFE

Answer 12

slipped upper femoral epiphysis

- head of femur ‘slips’ along the growth plate

Question 13

who typically gets a SUFE

Answer 13

obese boys 10-15 years old

Question 14

main clinical sign in SUFE

Answer 14

loss of internal rotation

Question 15

Ix of SUFE

Answer 15

Xray

Question 16

management of SUFE

Answer 16

pin in the femoral head

Question 17

what is osteomyelitis

Answer 17

infection in the bone + bone marrow

• typically in the metaphysis of long bones
• staph. aureus most common cause

Question 18

presentation of osteomyelitis

Answer 18

often a risk factor that predisposes the child - open fracture / orthopaedic surgery / immunocompromised
subacute pain, swelling, tenderness

Question 19

Ix of osteomyelitis

Answer 19

MRI

blood culture

Question 20

what is DDH

Answer 20

developmental dysplasia of the hip

- abnormal development of bones during pregnancy leading to hip instability with tendency to sublux / dislocate

Question 21

signs of DDH

Answer 21

different leg lengths
extra thigh skin fold
+ Barlows / Ortolanis test

Question 22

what are Barlows + Ortolani tests

Answer 22

Barlows - attempts to dislocate femoral head

Ortolanis - attempts to relocate a dislocated femoral head

Question 23

which infants require USS screening for DDH at 6 weeks?

Answer 23

breech > 36 weeks
multiple pregnancy
+ ve frist degree relative with hip problems

Question 24

management of DDH infant < 6 months

Answer 24

Pavlik harness

- keeps hips flexed + abducted

Question 25

what is Talipes equinovarus

Answer 25

Clubfoot | - fixed abnormal ankle position: plantar flexion + supination

Question 26

tx of talipes equinovarus

Answer 26

Ponseti method | - casts used to hold foot in normal position

Question 27

what causes Rickets

Answer 27

vitamin D or calcium deficiency | called osteomalacia in adults

Question 28

what is Osgood Slatters disease

Answer 28

osteochondritis caused by inflammation at the tibial tuberosity

Question 29

presentation of Osgood Slatters disease

Answer 29

palpable tender lump at tibial tuberosity | anterior knee pain exacerbated by physical activity, kneeling or knee extension

Question 30

management of Osgood Slatters disease

Answer 30

reduction in physical activity NSAIDs Ice

Question 31

what is osteogenesis imperfecta

Answer 31

genetic condition that results in brittle bones that are prone to fractures

Question 32

presentation of osteogenesis imperfecta

Answer 32

recurrent fractures blue / grey sclera of the eyes short stature early onset deafness

Question 33

management of osteogenesis imperfecta

Answer 33

cannot be cured, can only manage symptoms + prevent fractures - biphosphonates - Vit D supplements - physio + occupational therapy

Question 34

knee pain post exercise with intermittent swelling / locking

Answer 34

osteochondritis dessicans

Question 35

how should a child < 3 years old with a limp be managed

Answer 35

urgent hospital assessment

Question 36

investigation of DDH after 4.5 months old

Answer 36

XRAY