paediatric orthopaedics

Question 1

developmental dysplasia of the hip risk factors

Answer 1

• first born
• female
• breech position
• family history
• increased birth weight
• having other congenital disorders

Question 2

developmental dysplasia of the hip pathophysiology

Answer 2

• occurs when there is dislocation and subluxation of the femoral head from the acetabulum during the prenatal period
• failure to maintain close apposition of the components of the hip joint will result in a shallow acetabulum, altered biomechanics, one limb being shorter than the other and ultimately accelerated osteoarthritis of the affect hip
• more common in left hip

Question 3

developmental dysplasia of the hip presentation

Answer 3

• limb shortening
• asymmetric groin
• asymmetric skin folds of groin

Question 4

in developmental dysplasia of the hip ultrasound if

Answer 4

• first degree family history of hip problems in early life
• breech at or after 36 weeks
• multiple pregnancy

Question 5

what is Ortolani test

Answer 5

• abduction and pressing the hip anteriorly
• positive test if clunking sound is heard due to relocation of the femoral head into the acetabulum

Question 6

what is Barlow’s test

Answer 6

• adduction and pressing leg posteriorly
• positive test if clicking sound heard due to dislocation of the femoral head

Question 7

developmental dysplasia of the hip diagnosis

Answer 7

• ultrasound
• if child if > 4.5 months –> x-ray

Question 8

developmental dysplasia of the hip management 0-6 months

Answer 8

Pavlik’s harness for 3 months

Question 9

developmental dysplasia of the hip management 6-18 months

Answer 9

closed reduction and 3 month hip spica cast

Question 10

developmental dysplasia of the hip management > 18 months

Answer 10

open reduction and femoral osteotomy

Question 11

transient synovitis is most common in

Answer 11

boys aged 2-10

Question 12

transient synovitis causes

Answer 12

most commonly following on from respiratory viral infection

Question 13

what is transient synovitis

Answer 13

self limiting inflammation of the synovium of the hip joint

Question 14

transient synovitis presentation

Answer 14

• limp
• reluctance to weight bear
• restricted range of movement
• low grade fever

Question 15

transient synovitis diagnosis

Answer 15

• exclusion
• rule out septic arthritis by doing bloods and cultures

Question 16

transient synovitis management

Answer 16

NSAIDs, rest and review

Question 17

Perthes disease is most common in

Answer 17

short, active boys 4-9 years old

Question 18

what is Perthes disease

Answer 18

• idiopathic osteochondritis of the femoral head
• results in transient loss of blood supply to the femoral head and eventually avascular necrosis and abnormal growth

Question 19

Perthes presentation

Answer 19

• limp
• pain in hip/knee
• usually unilateral
• loss of internal rotation
• loss of abduction
• Trendelenburg gait

Question 20

Perthes diagnosis

Answer 20

• x-ray showing joint space widening, decreased size of femoral head, collapse and deformity of the femoral head
• if x-ray if normal then MRI

Question 21

Perthes management

Answer 21

• bed rest, analgesia, avoidance of exercise and regular monitoring
• osteotomy (only indicated if severe subluxation and deformity of the femoral head)

Question 22

slipped upper femoral epiphysis is most common in

Answer 22

obese boys aged 10-16

Question 23

what is slipped upper femoral epiphysis

Answer 23

femoral head epiphysis slips inferiorly from neck of femur

Question 24

slipped upper femoral epiphysis presentation

Answer 24

• limp
• pain (hip, anterior thigh, knee)
• unable to weight bear

Question 25

slipped upper femoral epiphysis management

Answer 25

surgical stabilisation of the epiphysis (internal fixation)

Question 26

genu varum causes

Answer 26

- Rickets - trauma - osteochondroma

Question 27

what is genu varum

Answer 27

- pathological amount of varus in the tibia and fibula --> bow legs - normally resolves by 4

Question 28

genu valgum causes

Answer 28

- idiopathic - trauma - enchondroma

Question 29

what is genu valgum

Answer 29

- normal legs have small degree of valgus - pathological amount of valgus in the tibia and fibula --> knock knees

Question 30

patellofemoral dysfunction is most common in

Answer 30

adolescent girls

Question 31

patellofemoral pain disorder is most common in

Answer 31

athletes (especially those with recent increase in activity/experiences recent trauma)

Question 32

patellofemoral pain disorder presentation

Answer 32

anterior knee pain on walking up the stairs or after prolonged periods of sitting

Question 33

patellofemoral pain disorder management

Answer 33

rest, analgesia and physiotherapy

Question 34

Osgood Schlatter disease is most common in

Answer 34

boys aged 10-15 years old

Question 35

what is Osgood Schlatter disease

Answer 35

inflammation of the tibial tuberosity, which is the site of attachment of the patella ligament

Question 36

Osgood Schlatter disease presentation

Answer 36

- knee pain, history of strenuous activity - pain worse on contraction of the quadriceps (straight leg raise)

Question 37

Osgood Schlatter disease management

Answer 37

rest, analgesia and physiotherapy

Question 38

club foot (talipes equinovarus) cause

Answer 38

develops due to abnormal alignment of the joint between the talus, calcaneus and navicular bones

Question 39

club foot (talipes equinovarus) risk factors

Answer 39

- male - family history - breech position - low amniotic fluid content during development

Question 40

club foot (talipes equinovarus) presentation

Answer 40

- plantar flexion of the ankle - supination of the forefoot - varus alignment of the forefoot

Question 41

club foot (talipes equinovarus) management

Answer 41

Ponsetti technique - regime of serial casts started soon after birth - most children require Achilles tenotomy - brace worn 23 hours a day for 3 months and then at night until the age of 3

Question 42

what is Salter Harris classification type 1

Answer 42

complete separation of the epiphysis

Question 43

what is Salter Harris classification type 2

Answer 43

complete separation of the epiphysis with a small fragment of metaphysis

Question 44

what is Salter Harris classification type 3

Answer 44

intra-articular fracture of the epiphysis

Question 45

what is Salter Harris classification type 4

Answer 45

intra-articular fracture of the epiphysis with a small fragment of metaphysis

Question 46

what is Salter Harris classification type 5

Answer 46

compression fracture that doesn't show up on x-ray and is associated with growth arrest and angular deformity

Question 47

what is a supracondylar fracture

Answer 47

supracondylar area of humerus fracture

Question 48

supracondylar fracture management

Answer 48

K wires

Question 49

what is a radial buckle fracture

Answer 49

buckle fractures of radius occurring within the metaphysis

Question 50

radial buckle fracture cause

Answer 50

arise due to compression of one side of the bone, causing the opposite side to bend away

Question 51

radial buckle fracture diagnosis

Answer 51

x-ray showing bulge on metaphysis of radius

Question 52

radial buckle fracture management

Answer 52

splint for 3-4 weeks

Question 53

what is a Greenstick fracture

Answer 53

incomplete fracture of the diaphysis of the radius

Question 54

Greenstick fracture cause

Answer 54

arise due to bending of the forearm, with the fracture occurring on the convex side (bulging side)

Question 55

Greenstick fracture management

Answer 55

cast and closed manipulation if angulated

Question 56

what is a toddler's fracture

Answer 56

fracture of the tibia that isn't displaced

Question 57

toddler's fracture presentation

Answer 57

irritable child that is reluctant to weight bear

Question 58

toddler's fracture management

Answer 58

cast