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paeds ortho Flashcards

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1
Q

how are fractures to the growth plate graded?

A

Salter-Harris classification (SALTR)

type 1 = Straight across
type 2 = Above
type 3 = beLow
type 4 = Through
type 5 = cRush
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2
Q

pain management in childrens fractures

A
  1. paracetamol or ibuprofen
  2. morphine

**codeine + tramadol are NOT used in kids, aspirin contraindicated in U16s (except Kawasaki)

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3
Q

risk factors for DDH

A 
1st degree fam history
breech presentation from 28 weeks (feet first)
multiple pregnancy (twins)
female 
down syndrome
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4
Q

presentation of DDH

A

different leg lengths
restricted hip abduction on one/both sides
difference in knee level when hips are flexed (positive Galeazzi sign)
clunking of hips on Ortolani + Barlow test

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5
Q

Ortolani test

A

DDH

starts dislocated will reduce - push from behind will pop upwards

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6
Q

Barlow test

A

DDH
starts reduced - will dislocate
pushing down so hip pops back

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7
Q

diagnosis of DDH

A 
<3months = US
>3months = x-ray
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8
Q

management of DDH

A

<6months = Pavlik harness - keeps hips flexxed + abducted, 6-8weeks

> 6months or harness fails = surgery - hip spica cast post-surgey

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9
Q

Slipped upper femoral epiphysis (SUFE)

A

head of femur is displaced (slips) along growth plate

  • boys aged 8-15 + obese
  • suspected if pain is disportionate to minor trauma
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10
Q

SUFE presentation

A

hip, groin, thigh, or knee pain (knee pain = examine hip)
restricted range of hip movement - esp. internal rotation
painful limp
patient will prefer to keep hip externally rotated

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11
Q

management of SUFE

A

surgery - pin femoral head in correct position + fix it preventing further slipping

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12
Q

transient synovitis

A

“irritable hip”
commonest cause of hip pain aged 3-10
associated with recent viral upper respiratory tract infection

NO fever if fever + joint pain urgent for septic arthritis

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13
Q

transient synovitis presentation

A

limp
refusal to weight bear
groin or hip pain

previous viral URT

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14
Q

management of transient synovitis

A

analgesia
safety net - attend A&E if develop fever
usually resolve 1-2weeks

follow up at 48hrs + 1 week

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15
Q

Pethes disease

A

disruption of blood flow to femoral head causing AVN
affects epiphysis of femur
idiopathic, severity varies

overtime there’s revascularisation of femoral head - remodelling of bone as it heals

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16
Q

what age and gender is Perthes disease more common in?

A

boys aged 4-12 yrs - particularly 5-8yrs

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17
Q

presentation of Perthes disease

A

slow onset of -

  • pain in hip or groin
  • limp
  • restricted hip movements
  • referred pain to knee

**no history of trauma - if trauma think SUFE (esp. in older kids)

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18
Q

complications of Perthes

A

soft + deformed femoral head (from remodelling as it heals)

leads to -

  • early hip OA
  • artificial total hip replacement in 5% of patients
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19
Q

Perthes investigations

A

x-ray

  • femoral head deformity
  • widening of femoral neck (coxa magna)
  • sclerotic lie running across femoral neck

MRI if x-ray normal

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20
Q

management of Perthes

A

depends on severity

  • bed rest, analgesia, traction/crutches, physio
  • regular x-rays to assess healing
  • surgery in v severe cases, older kids or those not healing
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21
Q

foot position in talipes equinovarus

A

plantar flexion + supination

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22
Q

foot position in talipes calcaneovalgus

A

dorsiflexion + pronantion

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23
Q

treatment of talipes (clubfoot)

Study These Flashcards
A

Ponseti method
- repeated casts until in correct position - may require Achilles tenotomy

  • after cast brace is used when not walking until kid 4ish y/o (“boots + bars”)
24
Q

tarsal coalition

Study These Flashcards
A

abnormal brige between talus + calcaneus
- painful fixed flat foot

Mx = splintage, orthotics, surgery to remove abnormal connection

25
spondylolithesis
slippage of one vertebra over another -- usually L4/5 or L5/S1 presents usually adolescence developmental or recurrent stress fracture that fails to heal
26
presentation of spondylolisthesis
low back pain radiculopathy (pinching of nerve root in spinal column) with sever slippage "flat back" - due to muscle spasm
27
management of spondylolisthesis
minor = rest + physio severe = stabilisation + possibly reduction (risk of neurological injury)
28
osteogenesis imperfecta
genetic mutations that affect maturation + organisation of type 1 collagen brittle bones prone to fractures 8 types - vary in severity
29
presentation of osteogenesis imperfecta
``` *blue/grey sclera* reccurent + inappropriate fractures hypermobility triangular face short stature deafness from early adulthood dental problems bone deformities - scoliosis, varus ``` diagnosis = clinical
30
management of osteogenesis imperfecta
biphosphonates - to increase bone density vit D supplementation MDT - physio, occ., paeds, social workers
31
achondroplasia
(short stature/dwrfism) - autosomal dominent or sporadic - prominent forehead + widened nose - recurrent otis media due to cranial abnormalities
32
Ehlers-Danlos syndrome
abnormal elastin + collagen | joint hypermobility, vascular fragility, scoliosis
33
Duchenne muscular dystrophy
boy starts to walk with difficulty standing (Gower's sign) can't walk by age 20, progressive cardiac + resp failure in early 20s
34
how do you diagnose + treat Duchenne muscular dystrophy?
diagnosis = raised serum creatinine phosphokinase + abnormalities on biopsy Mx = spplintage, physio
35
cerebral palsy
due to an insult to immature brain before, during, or after birth onset before 2-3 yrs expression + severity variable depending on where it is in the brain
36
causes of cerebral palsy
``` more often no identifiable cause genetic problems brain malformation, intracranial haemorrhage infection during early pregnancy prematurity hypoxia during birth meningitis ```
37
cerebral palsy presentation
failure to meet milestones increased/decreased tone generally or specific limbs hand preference <18months problems with speech, coordination or walking learning difficulties
38
types of spina bifida
2 halves of posterior vertebral arch fail to fuse - first 6 weeks gestation occulta = mildest, dimple over area, high arched foot/clawing of toes meningocele = herniation of meninges alone myelomeningocele = herniation of meninges + cauda equina
39
treatment spina bifida
defect usually closed within 48hrs of birth
40
obstetric brachial palsy
brachial plexus injury during vaginal delivery common in - large babies, twins, shoulder dystocia (shoulder stuck during birth) Erb's palsy (upper) Klumpke's palsy (lower) - prognosis WORSE than Erb's (no treatment)
41
what part of the brachial plexus is injured in Erb's palsy?
C5 + C6
42
Erbs palsy presentation
loss of motor innervation of arm muscle (biceps) | leads to internal rotation of humerus - may lead to waiters tip posture
43
management of Erbs palsy
(C5 + C6) physio surgical release of contracture + tendon transfers if no recovery ->prognosis is based on return of biceps function by 6 months
44
what part of the brachial plexus is injured in Klumpke's palsy?
C8 + T1
45
Klumpke's palsy
C8 + T1 injury paralysis of intrinsic hand muscle +/- fingers+ wrist possible horners syndrome NO treatment
46
risk factors for rickets
breastfed babies - formula fed is fortified with vit D darker skin, low exposure to sunlight, colder climate, lots of time indoors
47
presentation of rickets
``` may not have any symtpoms lethargy bone pain swollen wrists varus, valgus rachitic rosary soft skull delayed teeth abnormal fractures ```
48
what is rachitic rosary + craniotabes?
rachitic rosary = ribs expand at costochondral junc, causing lumps along chest craniotabes = soft skull, delayed closure of sutures + frontal bussing --> both signs of rickets
49
rickets investigations
serum 25-hydroxyvitamin D (<25 = deficient) x-ray required to diagnose = translucent bones serum ca + phosphate = low serum alkaline phosphatase = high parathyroid hormone = high
50
what would serum alkaline phosphatase + parathyroid hormone levels be like in rickets?
both HIGH
51
serum calcium + phosphate levels in rickets?
LOOOOW
52
management of rickets
breastfeeding women should take vit D supplement ergocalciferol (vit D for kids) - dose dependents on age calcium supplementation
53
what is Jacks test used for
flat feet mobile/flexible = flattened medial arch forms with dorsiflexion of great toe rigid = remain flat regardless of load or dorsiflexion - underlying tarsal coalition or inflammatory or neurological disorder
54
angulation of the distal segment of bone away from midline
valgus
55
angulation of distal segment of bone towards midline
varus

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