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Ortho > Paeds > Flashcards

Paeds Flashcards

1
Q

Clinical findings of congenital muscular torticollis?

A

Plagiocephaly
Facial asymmetry
Decreased neck movement

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2
Q

Etiology of congenital muscular torticollis?

A

Birth trauma
Vascular
Compartment syndrome

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3
Q

Causes of painful limp?

A

Infection
Inflammation
Osteochondrosis
Trauma
Tumour

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4
Q

Infection in painful limp?

A

Hip & Knee - Septic arthritis
LL - osteomyelitis

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5
Q

Inflammation in painful limp?

A

Hip = TSH, JRA
Knee, Ankle, Foot = JRA

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6
Q

Transient synovitis of hip?

A

4-8 yo
Hx of URI in past 2 weeks
Looks well
No fever

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7
Q

Differentials of TSH?

A

Inflammatory arthritis
Perthes Disease
Septic arthritis

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8
Q

Manifestation of Perthes?

A

4-10yo, mostly boys
Short for age
Bone age 2-3 years behind chronological age

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9
Q

EArly complications of Supracondylar frac?

A

MN damage [AIN]
Artery [Brachial] - compt syndrome, Volkmann’s
UN damage

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10
Q

Late complications of supracondylar frac?

A

Non-union
Malunion -> CUBITUS VARUS
Stiffness

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11
Q

Gartland classification for supracondylar frac?

A

1 = undisplaced
2 = displaced in 1 plane
3 = Displaced in 2/3 planes
4 = complete periosteal disruption with instability in flexion and extension

Treat with cast for Type 1
CRPP most common for 2/3/4

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12
Q

What is Iselin’s disease?

A

Caused by traction apophysitis of the the peroneus brevis tendon at the tuberosity of the fifth metatarsal in children and presents with lateral foot pain.

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13
Q

What is Osgood Schlatter’s disease?

A

osteochondrosis or traction apophysitis of the tibial tubercle, commonly presenting as anterior knee pain

Just manage with NSAIDs + activity modification

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14
Q

How to diagnose Osgood Schlatter’s

A

Clinical diagnosis with **enlarged tibial tubercle **
XR shows irregularity and fragmentation of the tibial tubercle

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15
Q

How to diagnose Iselin’s disease?

A

Clinical diagnosis with pain over 5th MT base.
XR shows enlarged apophysis with disordered ossification and widened chondro-osseous junction.

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16
Q

When to confirm diagnosis of DDH?

A

With **US in first 4 months, **
Radiographs 4-6 months after femoral head ossification occurs

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17
Q

Treatment options for DDH?

A

Pavlik bracing
Surgical reduction, osteotomy etc.

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18
Q

In which hip is DDH more common?

A

In left hip [60%]. Due to more common intrauterine position being occiput anterior

Bilateral in 20%.

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19
Q

DDH is a spectrum that includes ____

5 things

A

Dysplasia
Subluxation
Dislocation
Teratologic hip
Late (adolescent) dysplasia

20
Q

What conditions is DDH a/w?

A

Congenital muscular torticollis 20%
Metatarsus adductus 10%
Congenital knee dislocation

21
Q

Classification of DDH?

A

Subluxable = Barlow-suggestive
Dislocatable = Barlow-positive
Dislocated = Ortolani positive early if reducible

Ortolani-negative late when irreducible dislocation

22
Q

PE confirmation for DDH?

A

Barlow = dislocates a dislocatable hip by adduction and depression of flexed femur
Ortolani = reduces dislocated hip by elevation + abduction of flexed femur

Barlow = “Click of exit”
Ortolani = “click of entry”

Barlow-Ortolani rarely positive after 3 months

23
Q

What PE to do from 3 months - 1 year for DDH?

A

Limitations in hip abduction.
Occurs as laxity resolves and stiffness begins to occur.
LLD predominates

24
Q

**Salter-Harris **classification to grade fractures in kids that involve physial plate?

A

Separated GP
Above GP
Below GP
Through GP
ERasure of GP

GP = Growth plate

25
Q

Common age for Transient Synovitis of Hip?

A

4-8 years
MUST be differentiated from septic arthritis of hip

M:F ratio 2:1

26
Q

RF for transient synovitis?

A

**URTI Hx in last 2 weeks **
Bacterial infection
Trauma
Allergy

27
Q

What is natural position of hip in Transient Synovitis?

A

Flexion, abduction, external rotation

Lowest intracapsular pressure

28
Q

Presentation of Transient Synovitis of hip?

A

Groin/Hip pain.
Limp (main)
No fever

MUST be differentiated from septic arthritis

29
Q

Mx for Transient Synovitis of hip?

A

Just rest. NSAIDs if want meds

If symptoms improve with NSAIDs, then likely TS

30
Q

How to differentiate btw TS and septic arthritis?

A

CRP<20mg/l in TS. Most impt factor TRO Septic arthritis.
Invasive studies of synovial fluid aspiration can also be done

31
Q

What is Perthes disease?

Coxa Plana

A

Idiopathic AVN of proximal femoral epiphysis in children

Can cause Trendelenberg gait

Usually unilateral. If bilateral, think skeletal dysplasia instead

32
Q

Mx of Perthes’ Disease?

A

Observation/symptomatic if <8yo
Femoral and/or pelvic osteotomy >8yo

Symptomatic can mean like simply restoring ROM or analgesia

33
Q

What is teratologic dislocation of hip?

A

Congenital dislocation which is irreducible by gentle manipulation at birth

34
Q

What is Slipped capital femoral epiphysis

A

Slippage of metaphysis relative to epiphysis.
Common in adolescent obese males

More common in left hip. But can be bilateral too

35
Q

Mx for Slipped capital femoral epiphysis?

A

Usu percutaneous pin fixation.
Contraleteral pinning for high risk patients.

36
Q

Secondary causes or RFs for SCFE?

A

Fat, pubertal boys
Endocrine causes -> hypoT, hypoGonadism etc. They weaken physis + overgrowth

Bilateral SCFE points towards endocrine

37
Q

Presentation of SCFE?

A

Knee pain + painful limp + Hip/groin pain
Can have referred pain to ant thigh or knee

38
Q

What is Osteochondritis Dissecans

A

Separation of small osteocartilaginous fragment from femoral condyle articular surface, usu a/w hx of trauma

Poorly localized knee pain. Activity related.

39
Q

When does osteochondritis dissecans occur?

A

10-15 yo when physis still open.
Adult form exists too.

40
Q

Physiological evolution of leg alignment?

A

-18 months = Genu varus (tibial intorsion)
1.5yo - 2 yo = Neutral
2 - 6yo = Genu valgum (Ligamentous laxity)
7 yo = Normal valgus angle (<12˚)

41
Q

What is Chondromalacia Patellae?

A

Idiopathic articular changes to patella causing anterior knee pain

Mostly adolesents and young adults

42
Q

PE of chondromalacia patellae?

A

Quadriceps atrophy
Patella maltracking
Palpable crepitus
Pain with patellar compression
Limited knee ROM

43
Q

XR findings of Chondromalacia patellae?

A

May see chondrosis on XR
Shallow sulcus, patella alta/baja, lateral patella tilt

44
Q

What is Kohler’s disease?

A

Avascular necrosis of navicular bone.
Pain on dorsal and medial surface of foot

45
Q

Postural vs Structural scoliosis?

A

Secondary tilt to compensate for extra-spinal conditions
vs
Fixed primary tilt a/w abnormal bone & vertebral rotation

46
Q

Mx of frac or dislocation in kids?

A

If frac close to growth plate, remodelling potential is great and not much is needed.
Child under 10 = remodelling even with 100% displacement
Pre-pubertal = Under 20deg angulation is acceptable

47
Q
A

Ortho (11 decks)

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