Paeds orthopaedics

Question 1

• Septic arthritis is most common in children of what age?

Answer 1

under 4

Question 2

• Septic arthritis is a common and important complication of

Answer 2

joint replacement

Question 3

• Septic arthritis presentation

Answer 3

Question 4

• …is the most common causative organism of septic arthritis. Other bacteria include:

Answer 4

Question 5

Septic arthritis differentials

Answer 5

Question 6

Investigation findings and management of septic arthritis

Answer 6

Question 7

Slipped upper femoral epiphysis (SUFE) definition

Answer 7

head of the femur is displaced (“slips”) along the growth plate

Question 8

Slipped upper femoral epiphysis (SUFE) more common in which group? Typical age presentation

Answer 8

It is more common in boys and typically presents aged 8 – 15 years, with the average age of 12 in boys.
It presents slightly earlier in females, with an average age of 11 years.

It is more common in obese children.

Question 9

Slipped upper femoral epiphysis (SUFE) presentation including examination findings

Answer 9

Question 10

SUFE investigations

Answer 10

The initial investigation of choice in SUFE is xray.

Other investigations that can be helpful in establishing the diagnosis are:

• Blood tests are normal, particularly inflammatory markers used to exclude other causes of joint pain
• Technetium bone scan
• CT scan
• MRI scan

Question 11

SUFE management

Answer 11

Surgery is required to return the femoral head to the correct position and fix it in place to prevent it slipping further.

Question 12

Perthes disease definition and age group

Answer 12

Question 13

Perthes disease main complication

Answer 13

Question 14

Perthes presentation

Answer 14

Question 15

perthes vs SUFE differentation in presentation

Answer 15

no history of trauma in perthes. If the pain is triggered by minor trauma —> slipped upper femoral epiphysis, particularly in older children.

Question 16

investigations in perthes

Answer 16

Question 17

Perthes management

Answer 17

Question 18

Reactive arthritis definition and presentation

Answer 18

Reactive arthritis involves synovitis in one or more joints in response to an infective trigger.

Typically it causes acute monoarthritis, affecting a single joint (most often the knee), presenting with a warm, swollen and painful joint.

Question 19

reactive arthritis important differential

Answer 19

A significant differential is septic arthritis, where an infection is inside the joint. Patients with reactive arthritis do not have an infection in the joint.

Question 20

The most common triggers of reactive arthritis are

Answer 20

gastroenteritis or sexually transmitted infections.

Chlamydia may cause reactive arthritis.

Gonorrhoea typically causes septic arthritis rather than reactive arthritis.

Question 21

Reactive arthritis is what type of arthropathy?

Answer 21

seronegative spondyloarthropathy

There is a link with the HLA B27 gene

Question 22

Reactive arthritis is more common in patients with

Answer 22

HIV
(HIV needs to be excluded in patients with reactive arthritis)

Question 23

Reactive arthritis associated conditions

Answer 23

• Bilateral conjunctivitis (non-infective)
• Anterior uveitis
• Urethritis (non-gonococcal)
• Circinate balanitis (dermatitis of the head of the penis)

TOM TIP: The classic triad of conjunctivitis, urethritis and arthritis are remembered with the mnemonic, “can’t see, pee or climb a tree”.

Question 24

Reactive arthritis investigations and management

Answer 24

Question 25

DDH definition and what it leads to

Answer 25

Question 26

How is DDH usually picked up?

Answer 26

DDH is either picked up during the **newborn examinations** or later when the child presents with hip asymmetry, reduced range of movement in the hip or a limp.

Question 27

Risk factors of DDH

Answer 27

Question 28

Screening for DDH including examination findings

Answer 28

Question 29

Diagnosis of DDH

Answer 29

Question 30

Management of DDH

Answer 30

Question 31

Transient synovitis cause

Answer 31

temporary (transient) irritation and inflammation in the synovial membrane of the joint (synovitis). It is the most common cause of hip pain in children aged 3 – 10 years. It is often associated with a recent **viral upper respiratory tract infection**.

Question 32

the most common cause of hip pain in children aged 3 – 10 years

Answer 32

transient synovitis

Question 33

transient synovitis vs septic arthritis

Answer 33

Children with transient synovitis typically **do not have a fever**. Children with joint pain and a fever need urgent management for septic arthritis.

Question 34

Transient synovitis presentation

Answer 34

Question 35

Transient synovitis management

Answer 35

Question 36

Transient synovitis prognosis

Answer 36

Typically there is a significant improvement in symptoms after 24 – 48 hours. Symptoms fully resolve **within 1 – 2 weeks** without any lasting problems. Transient synovitis may recur in around 20% of patients.

Question 37

Rickets definition

Answer 37

Rickets is a condition affecting children where there is defective **bone mineralisation** causing “**soft**” and **deformed** bones. In adults the same process leads to a condition called osteomalacia. Osteo– means bone and –malacia means soft.

Question 38

Rickets causes

Answer 38

* deficiency in vitamin D or calcium * rare form of rickets caused by genetic defects that result in low phosphate in the blood. This is called **hereditary hypophosphataemic rickets**. The most common form is **x-linked dominant**, however it also has other modes of inheritance.

Question 39

Which conditions tend to have vitamin D deficiency?

Answer 39

* Patients with **malabsorption** disorders (such as **inflammatory bowel disease**) are more likely to have vitamin D deficiency. * The kidneys are essential in metabolising vitamin D to its active form, therefore vitamin D deficiency is common in **chronic kidney disease**.

Question 40

Inadequate vitamin D leads to...

Answer 40

Question 41

Presentation of rickets

Answer 41

Question 42

Bone deformities that can occur in rickets include:

Answer 42

Question 43

Risk factors to ask in history of rickets

Answer 43

risk factors for vitamin D deficiency in your exams and clinical practice. Patients with rickets are likely to have risk factors such as * darker skin * low exposure to sunlight * live in colder climates and * spend the majority of their time indoors.

Question 44

Investigations for rickets

Answer 44

Question 45

Management of rickets

Answer 45

Question 46

An older child with missed DDH may present with

Answer 46

An older child with missed DDH may present with a Trendlenberg gait and leg length discrepancy