Paediatrics > Paediatric orthopaedics > Flashcards

Paediatric orthopaedics Flashcards

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1
Q

What is the most common cause of hip pain?

A

Transient synovitis

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2
Q

Transient Synovitis : Definition

A

Self-limiting condition which is triggered by a viral infection and causes inflammation of the synovial

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3
Q

Transient Synovitis : Pathophysiology

A
  1. Viral infection : triggers an immune response
  2. Inflammation of synovial lining of the hip job
  3. Pain and inflammation of the unilateral hip joint
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4
Q

Transient Synovitis : Incidence

A
  • Male children
  • 3 years - 8 years
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5
Q

Transient Synovitis : Clinical features

A
  1. Preceding recent viral infection
  2. Unilateral hip/groin pain } develops acutely
  3. Limp/refusal to weight bear
  4. Systemically well - may have low grade fever
  5. Sx present for <72 hours
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6
Q

Transient Synovitis : Management

A

Self-limiting, requiring only rest and analgesia.

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7
Q

Slipped upper femoral epiphysis : Definition

A

Displacement of the femoral head, commonly seen in overweight children

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8
Q

Slipped upper femoral epiphysis : Pathophysiology

A
  1. Adolescence during growth spurt:
    * Growth plate is a weak area where growth occurs
  2. Increased stress on the hip joint
    * Mechanical stress
    * Obesity
  3. Head of the femur slips and is displaced at the growth plate - posterior-inferiorly
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9
Q

Slipped upper femoral epiphysis : Risk factor

A

Adolescence
Mechanical stress : Obesity, Trauma

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10
Q

Slipped upper femoral epiphysis : Clinical features

A
  1. Acute/Chronic :
    * Hip, medial thigh, knee pain
  2. Loss of internal rotation in flexion
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11
Q

Slipped upper femoral epiphysis : Investigation

A

XR - Frog-leg views

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12
Q

Slipped upper femoral epiphysis : Management

A

Surgery : internal fixation

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13
Q

Septic arthritis : definition

A

Infection of a joint - can progress to systemic infection

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14
Q

Septic arthritis : Clinical features

A
  1. Joint pain : Hip, Knee and Ankle (most common)
  2. Limp : unable to weight bear
  3. Systemically unwell : High Fever, lethargy
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15
Q

Septic arthritis : Clinical signs

A
  1. Red, hot swollen joint
  2. Limited range of movement
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16
Q

Septic arthritis : Investigation

A
  1. Bloods : Raised WCC, ESR
  2. Blood cultures
  3. Joint aspiration : Raised WCC, for culture
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17
Q

Perthes disease : Definition

A
  1. Disruption of the blood supply to the femoral head
  2. Leading to avascular necrosis - infarction of the bone - leading to femoral head deformity
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18
Q

Perthes disease : Incidence

A
  • 4-8 years old } during period of rapid growth increase
  • Boys : 5x more common
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19
Q

Perthes disease : Clinical features

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A
  1. Hip pain : progressive over few weeks
  2. Limp
  3. Stiffness and reduced range of movement
20
Q

Perthes disease : Investigation

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A

X-ray : Widening of joint space, decreased femoral head size/flattening

21
Q

Perthes disease : Management

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A
  1. Supportive Casts/Braces : keeps femoral head within the acetabulum
  2. < 6 years : Observation
  3. Surgical management
    Most cases resolve with conservative management
22
Q

Developmental dysplasia of the hip : Definition

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A

Congential disease which occurs when the hip joint does not develop properly in infants.

Presentation : Dysplasia to complete Dislocation of the hip joint

23
Q

Developmental dysplasia of the hip : Causes/Risk factors

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A
  1. Female (more common)
  2. Breech presentation : legs in breech are extended and affect development of hip in utero
  3. Oligohydramnios : low level of amniotic fluid limits baby’s movement
  4. Genetics : Family hx
24
Q

Developmental dysplasia of the hip : Clinical symptoms

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A
  1. Leg length discrepancy
  2. Level of knees when hips + knees are bilaterally flexed
  3. Restricted ROM : abduction of the hip in flexion
25
Developmental dysplasia of the hip : Clinical signs
* Barlow test: attempts to dislocate an articulated femoral head * Ortolani test: attempts to relocate a dislocated femoral head
26
Developmental dysplasia of the hip : Investigations
1. Screening; * New born check * 6 week baby check:  Barlow + Ortolani test 2. Ultrasound - if >5 months for X-ray
27
Developmental dysplasia of the hip : Management
1. Spontaneously resolve by 3-6 weeks 2. < 5 months : Pavllik harness
28
Chondromalacia patellae : Definition
Softening and degeneration of the underside of the knee cap
29
Chondromalacia patellae : Clinical features
1. Pain : * Surrounding or behind patella * Up/down Stairs : anterior knee pain * Pain around or behind knee * Pain after prolonged knee bending 2. Crepitus : When moving knee 3. Overuse/repetitve stress on the knee
29
Chondromalacia patellae : Incidence
Teenage girls
30
Chondromalacia patellae : Management
Physiotherapy
31
Osgood-Schlatter disease : Definition
1. Condition affecting sporty teenagers 2. Inflammation and pain at the tibial tuberosity
32
Osgood-Schlatter disease : Pathophysiology
1 . Tibial tuberosity * Has a growth plate * Patella tendon attaches to tibia 2 . Growth spurt * Bones and tendons grow at different rate * Increased tension on growth plate 3 . Pulling on patellar  tendon on the growth plate * Inflammation and pain
33
Osgood-Schlatter disease : Incidence
Athetic teenager : sports requiring flexion of the knees
34
Osgood-Schlatter disease : Clinical features
1. Pain below patella : tender tibial tuberosity, exacerbated by activity 2. Swelling and tenderness of tibial tuberosity
35
Patellar tendonitis : Definition
Inflammation of the patellar tendon causes by repetitive jumping/running or intense physical activity
36
Patellar tendonitis : Pathophysiology
1. Repetitve stress on tendon without adequate recovery time * Microscopic tears accumulate and cause inflammation
37
Patellar tendonitis : Clinical features
1. Anterior knee pain : below kneecap, where tendon attaches to tibia 2. Pain during and after activity 3. Tenderness and swelling of Patella tendon
38
Osteochondritis dissecans : definition
Triggered by chronic activity and causes by separation of cartilage and underlying bone
39
Osteochondritis dissecans : Pathphysiology
1. Repeated stress or trauma 2. Disruption of blood supply 3. Ischaemia, fragmentation and detachment * Necrosis : segment and underlying bone can become fragmented and detach from joint surface 4. Loose body formation * Detatched fragment may  remains within joint
40
Osteochondritis dissecans : Clinical features
1. Joint pain and swelling 2. Joint instability : catching and locking 3. Limited range of movement
41
Patellar subluxation : Definition
Partial dislocation of the patella from its position within the patellofemoral groove
42
Patellar subluxation : Incidence
Sporty children - high impact sport
43
Patellar subluxation :Clinical features
1. Instability / locking : knee may give away 2. Medial knee pain from lateral subluxation
44
Osteogenesis imperfecta : Definition
Autosomal dominant disorder - mutation of genes affecting synthesis of type 1 collagen
45
Osteogenesis imperfecta : Pathophysiology
* Bone fragility /high risk of fractures * Collagen is in the extra cellular matrix - contributes to bone strength * Abnormal bone formation : * Dysfunction collagen affects bone formation * Growth retardation
46
Osteogenesis imperfecta : Clincial features
1. Brittle teeth 1. Hypermobility 1. Blue sclera : thin and translucence of the scleral tissue which is caused by collagen abnormalities 1. Hearing loss : collagen is present in inner ear and abnormalities can cause hearing loss
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