Pediatric Orthopaedics (The Big 3) Flashcards

1
Q

This deck covers

A

Developmental Dysplasia of the Hip (DDH)
Perthes Disease
SUFE

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2
Q

Who gets DDH?

A

6x more in women

Mostly european races

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3
Q

What can predispose you to DDH?

A
Being first born
FH
Breech birth
Oligohydramnios
Having another lower limb deformity
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4
Q

Does DDH affect one hip more than another?

A

Yes 3x more likely in the left hip. Something to do with how you pass down the birth canal

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5
Q

What signs can be used to screen for DDH on a newborn exam?

A

Ortolani’s Sign
Barlow’s Sign
Piston Motion Sign

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6
Q

How do we confirm DDH?

A

Focussed Examination and US

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7
Q

How do we manage DDH?

A

Spica Casts (specific type of plaster cast designed to realign the joint)

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8
Q

Who gets perthes disease?

A

5M:1F

Around primary school age

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9
Q

How does perthes present?

A
Knee pain on exercise
Limp
Stiff hip
Systemically well
Shortening of hip

(15% are bilateral)

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10
Q

What is Legg-Calve-Perthes disease (LCP)?

A

Avascular necrosis of the head of the femur due to inadequate blood supply to the epiphysis

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11
Q

What are the phases of LCP?

A

Avascular necrosis
Fragmentation - revascularisation (painful)
Reossification - bone healing
Residual deformity

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12
Q

DDX for LCP?

A

Unilaterally it could be a septic hip, JIA, SUFE or a lymphoma

If its bilateral it’s more likely a systemic problem e.g. hypothyroid, sickle cell or epiphyseal dysplasia

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13
Q

What can we do to treat LCP?

A

Maintain the hip motion but restrict painful activities
Analgesia
Consider osteotomy

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14
Q

What is SCFE/SUFE?

A

Slipped capital/upper femoral epiphysis (same thing)

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15
Q

Who gets SCFE/SUFE?

A

9-14yrs

Mostly boys

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16
Q

What are the classes of SUFE?

A

Acute or chronic

Stable vs unstable

17
Q

What does SUFE look like?

A

hip or Knee pain

Ext rotated & reduced internal rotation (notable in posture & gait)

18
Q

How do we diagnose SUFE?

A

X-ray (AP & frog lateral)

19
Q

How do we classifying sufe based on the x-ray?

A

By how far off its slipped:

  • 1/3rd = mild
  • 1/3rd -> 1/2 = moderate
  • > 1/2 = severe
20
Q

How to treat Sufe?

A

Pinning in situ

21
Q

What complications can arise from sufe?

A

AVN (mostly unstable slips)
Chondrolysis
Deformity
Early OA

22
Q

Patient is 0-3yrs old, what conditions are you most likely to see?

A
SA (very common at any childhood stage)
Osteomyelitis
DDH (only in young'uns)
Toddler's fracture
NAI
23
Q

3-10 yr old patient, what conditions are you likely to see?

A

Trauma (bone & ST) - most common
SA (common at every age)

Transient synovitis
Perthes

24
Q

What’s most likely to affect a patient 11-15?

A
Trauma
SA
Osteomyelitis
SUFE (young teenagers)
Perthes