Paediatrics: Orthopaedics Flashcards
How can you clinically differentiate DDH, Perthe’s and SUFE in terms of
features
demographic
DDH // PD // SUFE
+ ve ortolani, barlows // hip +/- knee pain // shortened, internally rotated leg following knee pain history
Heavy, breech females // 5-12yrs // obese adolescent males
How do you investigate and treat DDH?
Investigations
US < 4.5 months <= X-ray
Treatment
3-6 weeks: await resolution
<4.5 months: Pavlik harness
>=4.5 months: Sugery
Investigations and treatment for perthe’s
Ix: X-ray shows flattened femoral head, fragmentation if late
Rx: Remove pressure
Investigation findings and treatment for SUFE
XR shows inferolateral displacement (melted ice cream cone)
How do you differentiate septic arthritis, TTH, JIA in terms of
Features
Demographic
SA // TTH // JIA
Acute pain + swelling // Acute pain // Chronic pain and swelling
Males > females // 2-10yrs // <16yrs
What criteria can help differentitate septic arthritis from TTH?
Kocher criteria (FERN)
- Fever >38.5
- ESR raised
- Raised CK
- Non-weight bearing
What joint pain symptom warrants urgent paeds assessment?
Fever
How do you treat septic arthritis, TTH, JIA?
Sepsis 6 // supportive // rheumatological referral
What history features help distinguish the following knee conditions
Osgood Schlatter
Patellar tendonitis
Chondromalacia patellae
Patellar subluxation
Osteochondritis dissecans
OS: Tibial tubercle pain, sporty teenagers
PT: Sub-patellar pain, teenage males
CP: Anterior knee pain worse on stairs, females
PS: Medial knee pain, can give way
OD: Post exercise, swelling and locking
What is the difference between plastic deformity, buckle, greenstick and complete fracture?
Degree of cortical disruption
None // partial // unilateral // bilateral
Outline Salter-Harris fractures I-IV
- straight across
- across and up
- across and down
- straight down
- Across and crushed down
