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3.3 paediatric orthopaedics - Coggle Diagram
3.3 paediatric orthopaedics
scoliosis
abnormal lateral curvature of the spine
10 degree
2% of F
0.5% of M
causes
idiopathic -- unknown
most common - 80%
2 types:
early onset <10y/o
late onset >10 y/o
congenital
failure of segmentation/formation
may require early surgery
neuromuscular
cerebral palsy
spina bifida
long curves & more rapidly progressive
higher rate of pulmonary complications in surgery
location
cervical
thoracic
most common
thoracolumbar
lumbar
uneven shoulder h
uneven hips/waist
prominence
Adam's forward bending test
touch toes & curvature seen
progression
age
post adolescence, rarely increases
curve magnitude
<20 rarely progresses
30 90% progresses
Risser sign
DDH = Developmental dysplasia of the Hip
spectrum from acetabular dysplasia - dislocation
not always congenital
breech position @ birth
female
first child
family hx - older sibling/mum/dad
symptoms
left hip affected >right (in utero vibes)
packaging problems
dx in infancy
depends on if infants hip is dislocated @ exam,
can have bilateral hip exams -> might miss dx
Ortalni/Barlow tests
Galeazzi sign - check if femur/tibia shorter R&L
limited hip adduction
v sensitive
Shenton's line btw femur & ischium
tx
pavlik harness
closed/open reduction of hip
osteotomies around pelvis/femur -> deepen socket
SUFE = slipped upper femoral epiphysis :
idiopathic/unknown
prepubescent
boys
african americans
high,thigh, knee pain
bilateral in 15-30% cases
limp/can't bear weight
tx
aimed to prevent further slippage to prevent early arthritis
over tx: causes avascular necrosis
septic arthritis
direct inoculation
post surgery
direct from bone (osteomyelitis) - hip, knee, shoulder, elbow
haematogenous spread
dx
Kocher's criteria
all 4 + = 96% septic arthritis
WBC > 12,000 cell/uL
inability to bear weight
fever >38.5
ESR >40 mm/h
inability to weight bear + high CRP = 74% chance
CRP >2mg/dl
Transient Synovitis (Hip)
inflammation of hip joint lining, non septic (Kocher criteria -)
decr ROM of hip
NSAIDs help usually
Osgood-Schlatter's Disease = Tibial Tubercle Apophyositis
male>F
jumpers/basketballers
bilateral in 20-30%
conservative tx
hamstrings do not lengthen in growth
CTEV
causes
idiotpathic
secondary
spina bifida
congenital bands
arthyro???
stiffening of joints @ birth
tx:
correct supination of foot
casting
ponseti technique (
BEST
)
surgery:
achilles tenotomy
postero-medial release
massive surgery - heal by
secondary intention
tests :
x-rays
AP & forced dorsiflexion lat
fractures
kids are unique for healing:
physis
thick periosteum
porous content
greenstick fractures
buckle fractures
tx
remodelling potential
in plane of motion
close to physis
rotation does not remodel
in plane of motion
Non Accidental Injury (NAI)
if unrecognised & sent home
25% risk of serious injury
5% risk of death
abuse = 2nd leaving cause of mortality in infants & children
young
first born children
premature infants
children w disabilities
most femoral fractures in children <1y/o = NAI (60-70%)
red flags
inconsistent hx
delay in presentation
reported injury insufficient to explain
hostile parents
fractures
femur fracture in young
humeral shaft fracture <3y/o
digital fracture before walking
metaphyseal corner (bucket handle fracture)
done by twisting
posterior rib fractures
