Paeds MSK Flashcards
(41 cards)
What is developmental dysplasia of the hip?
Ranges from hip dysplasia to complete dislocation
What are the risk factors for developmental dysplasia of the hip?
Females First born child Oligohydramnios Previous history of it in another child Big birth weight (>5kg) Breech presentation Congenital calcaneovalgus foot deformity
How would you detect developmental dysplasia of the hip in a newborn?
(on newborn exam or 8 week check up)
Barlow manoeuvre - to dislocate
Ortolani manoeuvre - to relocate
How would a child with developmental dysplasia of the hip present?
Limp / abnormal gait
Asymmetry of hip skin folds
Limited abduction or shortening of affected limb
+ on US of high risk groups
How would you confirm a diagnosis of developmental dysplasia of the hip?
US
How would you manage a child with developmental dysplasia of the hip?
Pavlik harness to keep hip flexed and abducted
If this doesn’t work or >6 months –> corrective surgery
CASE
A child with a fever, acutely painful limb
Won’t move it at all
O/E limb is swollen and tender, with an effusion in the joint below
Diagnosis?
Osteomyelitis
Trauma - fracture
Septic arthritis?
Bone tumour
Transient synovitis
How does osteomyelitis usually present?
+ in which bones
Distal femur and proximal tibia
Painful, immobile limb Fever Doesn't move the limb at all - movement causes pain Joint effusion Tender and swollen on examination
How would you investigate a child with suspected osteomyelitis?
Bloods:
- Raised WCC
- Raised ESR and CRP
- Positive blood cultures
CXR - nothing initially, then changes after about a week - new bone formation (subperiosteal) and localised bone thinning
MRI - differentiates bone from soft tissue swelling, shows subperiosteal pus and purulent debris in the bone
How would you manage a child with osteomyelitis?
Antibiotics - flucloxacillin basically for a long time - IV
then oral
If no response or / frank pus on aspiration / collection of pus / abscess - surgical drainage and debridement
+ rest limb in a splint and then mobilise
What are pathogens that commonly cause osteomyelitis?
Staph aureus
Streptococcus
Haemophilus influenzae
What are the risk factors for developing osteomyelitis?
Diabetes Sickle cell anaemia IV drug users Immunosuppression - due to HIV / medication Alcohol excess
CASE
A child with hip pain (sudden onset)
O/E decreased range of movement, mild fever
Diagnosis?
Transient synovitis (irritable hip)
Rule out septic arthritis
What are the symptoms of transient synovitis?
Acute hip pain
After viral illness
Decreased range of movement - lose internal rotation first
Mild fever
How would you investigate a child with sudden onset hip pain?
Bloods - ESR / CRP / WCC / cultures (for septic arthritis)
X ray - for fractures, trauma / slipped capital femoral epiphysis
US guided joint aspiration for septic arthritis
How would you manage a child with transient synovitis?
NSAIDS
bed rest - improves in a few days
CASE
Overweight 10 year old boy, with gradual onset hip / knee pain
What to look for on the history + exam
Differentials?
Hypothyroidism / hypogonadism for SCFE
Decreased range of movement - generally in Perthes, restricted abduction and internal rotation in flexion in SCFE
Slipped capital femoral epiphysis
Perthe’s disease
How would you investigate a child with gradual onset hip pain?
X ray - shows a slipper capital femoral epiphysis or in Perthes:
- Early joint space widening
- Later increased femoral head density
+ fragmented / irregular femoral head
How would you treat a slipped capital femoral epiphysis?
Surgical pin fixation
Gradual weight bearing
Therapy to increase range of movement
What are the complications of a slipped capital femoral epiphysis?
Avascular necrosis of the femoral head - Perthes disease
Chondrolysis - degeneration of the articular cartilage
What is Perthes disease?
Avascular necrosis of the capital femoral epiphysis
What are the symptoms associated with Perthes disease?
Gradual worsening hip / knee / pain, limp, stiffness
Decreased range of movement
What are the X ray changes associated with Perthes disease?
Fragmentation of the femoral head
Early = joint space widening
Later = increased femoral head density
How would you treat a patient with Perthes disease?
Rest
Physio
Plaster cast / surgery
