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Flashcards in Paediatric Joint Disease Deck (29):

What is the sinlge most reassuring feature in a child presenting to orthopaedics with joint disease?

That the symptoms ar symmetrical, this implies that it is a normal variant of growth


Give 5 example of normal variants of child growth that may present to orthopaedics

Flat feet
Toe Walkers
In-toeing Gait
Bow Legs
Knock Knees (Genu Valgum)


What is the medical term for a child with bow legs?

Genu Varum


What is the medical term for a child with Knock Knees?

Menu Valgum


A child presents whith tiptoe walking, what could be the underlying diagnosis?

It may be that this is a normal variant of growth
It may also be that the achilles tendon is particularly tight or that the child had cerebral palsy


What are the 3 levels at which causes of in-toeing in children can occur?



A child presents with in-toeing which you decide is caused by femoral ante version. What sign may you illicit?

The W Sign - when the child id sitting their feet are out-turn rather than sitting cross legged


What is genu varum and what would you think about if a child presents with this?

This is a normal variant in toddlers but in older children this could be a sign of rickets, however this is rare and is usually unilateral


What risk factors are associated wit Developmental Dysplasia of the hip?

Family History
breach Birth
Other congenital abnormalities


What is the most common underlying pathology behind developmental dysplasia of the hip?

A shallow acetabulum leading to instability and dislocation of the hip


What 2 clinical examinations will be carried out in a new born to screen for hip abnormalities?

Ortolani's Test
Barlow's Test


How is Barlow's test carried out?

The knee and hip are flexed to 90 degrees and a slight downward force is placed on the hips in an attempt to dislocate them


How is Ortolani's Test performed?

The hip and knee are fixed to 90 degrees and both hips are abducted in an attempt to reduce a dislocated hip


How does developmental dysplasia of the hip present?

Usually found in new-born check with Barlow's and Ortolani's but may present late with limping at walking.


What will be found on examination of a child who presents with late DDH? (3)

Disparity of leg length
Loss of Abduction
Asymmetrical posterior skin crease


How are babies with suspected Developmental Dysplasia of the hip investigated?

With US if clinical examination is positive of there are any other risk factors


What is the conservative treatment used in DDH?

A Pavlik Harness - abducts the legs and keeps the joint in place


What is Perthes Disease?

A rare disease where these is avascular necrosis of the femoral head


At what age will a child present with perthes disease and what symptoms and signs will they have?

Usually a boy will present aged 4-10 with progressive pain and limp in the affected hip(s). There will be reduced ROM and may be a fixed deformity


What is Slipped upper femoral epiphysis?

A disease where there is structural failure through the growth plate of an immaure hip.

It usually occurs in early adolescence and usually occurs bilaterally when the patient is overweight .

Will present with hip or knee pain and a limp.


How would Slipped upper femoral epiphysis be treated?

Immediate surgery to ensure there is not AVN


What is the medical term for 'clubfoot'?

Congenital Talipes Equinovarus


What are the 2 cardinal features of Talipes?

Inward pointing foot and calf wasting


What are the modalities and specifics of treatment of congenital talipes equinovarus ?

Conservative - Splinting and casting weekly for 3 months

Surgical - Only for those who are not repaired by splinting or those that reoccur later


What is the medical term brittle bone disease and what is the aetiology and pathology underlying it?

Osteogenesis Imperfecta - an autosomal dominant condition which leads to defect in the synthesis of Type I collagen


How does osteogenesis imperfect present?

Usually with low impact fractures or recurrent fractures with no other obvious cause. Blue sclera are pathognomonic


What 2 bone fractures are almost exclusively associated with non-accidental injury in young children?

Rib fractures and tibial metaphyseal fractures


A 14 year old boy presents complaining of pain just below his knee. He says he plays football 6 times a week as well as other sports and it is becoming sore when he runs. He has not had any injuries to the knee. What is the most likely diagnosis?

Osgood-Schlatter Disease.


What may be seen on X-ray in osgood-schlatters disease?

Fragmentation and sclerosis of the tibial tuberosity