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Paediatrics Flashcards

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1
Q

Describe the development of the femoral head

A

Mainly cartilage in childhood
Slowly ossifies with age
X-rays not as useful in paediatric hip assessment

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2
Q

What is developmental dysplasia of the hip

A

A disorder of abnormal development that results in dysplasia and possibly subluxation or dislocation
Instability of joint leads to dysplasia which gradually leads to dislocation

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3
Q

Which groups are most commonly affected by DDH

A

Left hips
Females
Native Americans and Laplanders

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4
Q

What is the pathophysiology of DDH

A

initial instability thought to be caused by maternal and fetal laxity, genetic laxity, and intrauterine and postnatal malpositioning

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5
Q

What are the risk factors for DDH

A

Firstborns - may be due to less intrauterine space
Females
Breech presentations
Family history
Oligohydramnios - low amniotic fluid volume

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6
Q

How does DDH present

A

Abnormality on screening - early
Limping child - short leg and trendelenberg
Decreased abduction, externally rotated leg
Pain later in life - due to arthritic changes

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7
Q

How do you diagnose DDH

A

Clinical exam - will have restricted abduction, different leg lengths
US
Radiographs in later years - AP X-ray

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8
Q

What is the Barlow test

A

Push backwards on hip joint to test if you can dislocate it

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9
Q

What is the ortolani test

A

If hip is already out of joint you abduct the hip to try and relocate

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10
Q

How can you treat DDH if it presents early

A

Pavlik harness - holds hips in position of safety
Worn 23hrs a day for up to 12 weeks
Serial USS to look for improvement

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11
Q

How can you treat DDH if it presents late

A

Surgery
Either a closed or open reduction
With tenotomy or osteotomy - cut tendon or bone

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12
Q

What is transient synovitis

A

Inflammation of the synovium
Often occurs secondary to a viral illness
Common in ages 0-5

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13
Q

How does transient synovitis present

A

History of viral illness but systemically well
Limp - antalgic
Hip/groin pain - may radiate to knee
Typically able to weight bear
Hip lies flexed and externally rotated
Pain at end range of movement - may decrease ROM

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14
Q

How do you diagnose transient synovitis

A

Blood tests
Kocher’s criteria
Ultrasound - looks for fluid in joint, may have effusion
Aspiration - rule out septic arthritis

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15
Q

What is Kocher’s criteria

A

Allows you to differentiate between transient synovitis and septic arthritis
List of clinical features - each one present increases risk of it being septic

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16
Q

How do you treat transient synovitis

A

Self-limiting condition
Rest
Analgesia or NSAIDs to cope with symptoms
If concerned offer review appointment

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17
Q

What is septic arthritis

A

Intra-articular infection of the joint

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18
Q

Why is septic arthritis (of the hip) a surgical emergency

A

High bacterial load in joint can lead to sepsis
Joint destruction due to proteolytic enzymes
Potential for necrosis

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19
Q

How does septic arthritis present in the hip

A

Short duration of symptoms
Unable to weight bear and hip/groin pain
Antalgic gait - limp
Hip lying flexed/externally rotated
Severe hip pain on passive movement - will have significantly decreased RPM
Usually pyrexial but may be haemodynamically stable
Raised WCC and CRP

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20
Q

How does septic arthritis arise

A

Direct inoculation - trauma or surgery
Hematogenous seeding - most common
Extension from adjacent bone (osteomyelitis)
Contiguous spread of osteomyelitis

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21
Q

What are some common causative organisms of septic arthritis

A

Neonates - Strep and gram -ve
Kids - staph aureus, haem influenza
Adults - staph aureus and strep
PWID - atypical

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22
Q

How do you diagnose septic arthritis

A 
Blood tests - FBC, CRP 
Blood cultures 
Kocher's criteria 
Radiographs - rules out other pathology
US +/- aspiration
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23
Q

How do you treat septic arthritis

A

Open surgical washout

Antibiotics - usually 6 weeks IV

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24
Q

What is Perthes disease

A

Avascular necrosis of the hip

Usually idiopathic

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25
What are some risk factors for Perthes disease
positive family history low birth weight second hand smoke Asian, Inuit, and Central European decent
26
Which groups most commonly get Perthes disease
Males - 5x more common 4-8 year olds Low socioeconomic class
27
Describe the pathophysiology of Perthes disease
Disruption of blood supply to femoral head leads to osteonecrosis Revascularisation occurs with subsequent reabsorption and collapse Remodelling eventually occurs
28
What are some potential mechanisms of Perthes disease (e.g. how it develops)
May be associated with abnormal clotting factors | Repeated trauma and mechanical overload could lead to collapse and repair
29
The older you present with Perthes, the better the prognosis - true or false
False | Younger presentations have better prognosis
30
What are the 4 stages of Perthes disease
Initial Fragmentation Reossification Remodelling
31
How does Perthes disease present
Gradual onset of painless limp Sometimes intermittent groin or knee pain Hip stiffness on internal rotation and abduction - reduced ROM Limp - short leg and trendelenberg
32
How do you diagnose Perthes
Radiographs - can be relatively normal in early stages MRI Look for flattened femoral head - progressive deformity
33
How do you treat Perthes disease
Aim is to keep femoral head round whilst the process self-terminates Restrict weight bearing and rest the joint Physio to maintain range of movement Surgery (osteotomy) for people with severe deformity
34
What is SUFE
Slipped upper femoral epiphysis | Affects the proximal femoral physis which leads to slipping of the metaphysis relative to the epiphysis
35
What are the risk factors for SUFE
``` Males Obesity Endocrine disorders Rapid growth spurts = physis cant cope with sudden increase in weight/pressure Can be triggered by minor trauma ```
36
What ages are normally affected by SUFE
10-16 | Common to have rapid growth
37
How do patients present with SUFE
Groin pain Pain in the knee or thigh Limp - antalgic or externally rotated foot Restricted IR and abd
38
How do you diagnose SUFE
Radiographs MRI -Looks like ice cream falling off the cone (head of femur off)
39
How do you treat SUFE
Surgery Percutaneous pinning of the hip May have to do open reduction if severe Often do the other side prophylactically
40
List 4 common congenital paediatric orthopaedic condtions
Clubfoot Rocker bottom foot Neurofibromatosis Skeletal dysplasia
41
List 4 common neruromuscualr paediatric orthopaedic condtions
Cerebral palsy Duchenne muscular dystrophy Cavus foot
42
What is the proper medical name for clubfoot
Congenital Talipes Equinovarus CTEV
43
What are the key features of clubfoot
Cavus - high arch Adductus - foot turned inwards Varus - heel points inward Equinus - fixed flexion
44
Who gets club foot
More boys than girls | 1/2 of cases are bilateral
45
What causes club foot
Mostly idiopathic | May be associated with more severe neuro conditions such as spina bifida
46
How do you treat club foot
Ponseti method Repeated casting of feet that gradually brings them to normal position Sometimes the Achilles is cut to allow this but it will heal
47
What is the proper name for rocker bottom feet
Congenital vertical talus
48
What causes rocker bottom feet
Irreducible dislocation of talus on navicular | Associated with more serious pathologies
49
What are the features of rocker bottom feet
rounded plantar surface | Equinus hindfoot -fixed position
50
What is neurofibromatosis
Congenital disorder - autosomal dominant | Affects the extremities, spine and skin
51
What are some key signs of neurofibromatosis
``` >6 café au lait spots >2 neurofibromas Freckles in axilla or inguinal Optic glioma (optic nerve tumour) >2 lisch nodules (in sclera) Cortical thinning or pseudoarthritis ```
52
What are skeletal dysplasia's
Refers to many congenital disorders that involve the bone and cartilage Abnormal development
53
What are features of skeletal dysplasia
Shorterning of involved bone Often short stature Can be proportionate or disproportionate
54
How can you classify skeletal dysplasia
According to area of bone affected OR According to pathophysiology
55
What is the most common form of skeletal dysplasia
Achondroplasia | Autosomal dominant condition but mostly caused by spontaneous mutations
56
What are the features of achondroplasia
Normal trunk with short limbs Genu varum Normal intelligence Motor delay
57
What is cerebral palsy
Non-progressive neuromuscular disorder | Common condition
58
what can cause cerebral palsy
Prematurity Traumatic birth Infection Meningitis
59
what are some signs of cerebral palsy
Muscle weakness Spasticity Abnormal muscle forces leading to dynamic deformity Contracture and fixed deformity
60
What is the most common type of muscular dystrophy
Duchenne muscular dystrophy
61
What Duchenne muscular dystrophy
Inherited disorder that presents at 2-5 years old X-linked recessive - affects boys Muscle gets replaced by fibrofatty tissue - leads to progressive weakness
62
What are the features of Duchenne muscular dystrophy
Muscle weakness - greater in proximal muscles Clumsy walking Positive Gower's sign Scoliosis
63
How do you diagnose Duchenne muscular dystrophy
creatine phosphokinase | muscle biopsy
64
What is the prognosis for Duchenne muscular dystrophy
Diagnosed age 2-5 Need walking assistance by 10 Wheelchair bound by 15 Many die by 20
65
What is Gower's sign
Walk hands up legs and thighs to get to upright position | Seen in Duchenne muscular dystrophy
66
Describe cavus feet
Have an elevated longitudinal arch and varus hindfoot (points in)
67
What can cause cavus feet
Idiopathic Familial 2/3 due to neurological disorder such as polio or cerebral palsy
68
How do you assess cavus feet
X-ray | Coleman block test - place block under toes and see if it corrects heel position
69
How do you manage cavus feet
Surgery Soft tissue if flexible deformity Bone if not flexible
70
What is a greenstick fracture
When the break only occurs in one cortex - seen if force applied to one side of bone The other cortex only bends Seen in children
71
In children, bones tend to bow rather than break - true or false
True
72
What causes a buckle fracture in children
Compressive force | Bone buckles in on itself
73
What is a plastic deformation
When neither cortex of the bone is broken but it is deformed as bone bends Seen in very young children
74
Point at which metaphysis connects to physis is an | anatomic point of weakness - true or false
True
75
Children's fractures heal faster than adults - true or false
True
76
What are the pros and cons of quick healing fractures in children
Pro - shorter immobilization times Con - mal-aligned fragments become “solid” sooner
77
Until what age can you expect bone remodelling after a fracture
Anticipate remodeling if child has > 2 years of | growing left
78
What is the most common elbow fracture seen in children
Supracondylar | This is the weakest part of the elbow joint
79
What is the fat pad sign
Sign of supracondylar elbow fracture Sail shaped fat shadow seen on X-ray - anterior portion may be normal but posterior is always pathological It may be the only sign in a non-displaced fracture
80
What other system must you always check in a supracondylar fracture
Vascular! Always check the pulse as there is a risk of vascular compromise - may need reduced Neuro - check function is intact
81
How do you treat a supercondylar fracture
Mostly conservatively | If displaced and damaged you can manipulate under anaesthetic and place wires
82
Majority of fractures in child < 1 year are from | abuse - true or false
True | Must consider NAI in all cases
83
Where are the most common fracture sites in NAI
Femur Humerus Tibia
84
What would make you suspect NAI
Unexplained fractures in different stages of healing Femoral fracture in child < 1 year Scapular fracture in child Epiphyseal and metaphyseal fractures of the long bones

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