p.44
Juvenile Idiopathic Arthritis
What is the role of physiotherapy in management?
To encourage mobility and maintain function.
What are less common hip causes in children of all ages?
Trauma and primary bone tumors.
p.42
Juvenile Idiopathic Arthritis
What are the early-onset complications associated with pauciarticular arthritis?
Iridiocyclitis and chronic uveitis.
p.36
Slipped Upper Femoral Epiphysis (SUFE)
What is Klein's line used for in radiology?
To assess the position of the femoral head in relation to the acetabulum.
p.2
Common Paediatric Pathologies
What types of treatment should be understood in paediatric pathology?
Both operative and non-operative treatments.
What is the purpose of a varus femoral osteotomy in Perthes disease?
To improve hip joint coverage and reduce stress on the femoral head.
p.43
Juvenile Idiopathic Arthritis
What joint issue can arise as a complication of certain conditions?
Flexion contracture of joints.
What is osteomyelitis?
An infection of the bone.
p.33
Slipped Upper Femoral Epiphysis (SUFE)
In which age group does SUFE typically occur?
In older children and adolescents due to rapid growth.
p.10
Septic Arthritis in Children
What are the sources of infection in Septic Arthritis of the hip?
Haematogenous spread, direct inoculation, and adjacent osteomyelitis.
p.2
Common Paediatric Pathologies
What is the focus of learning about common paediatric pathology?
To become familiar with common paediatric conditions.
What should be done if there is uncertainty in diagnosing a limp?
Admit the child for further investigations.
What is the management approach for early Perthes Disease?
Activity restriction and protected weight bearing.
p.11
Septic Arthritis in Children
Why is septic arthritis of the hip classified as an orthopedic emergency?
It can lead to irreversible joint damage.
p.3
Common Paediatric Pathologies
What are some examples of common paediatric pathologies?
Asthma, obesity, and infections.
What are common causes of limping in older children and adolescents?
Slipped Upper Femoral Epiphysis (SUFE), septic arthritis, DDH, Perthes disease, and Juvenile Rheumatoid Arthritis (JRA).
p.42
Juvenile Idiopathic Arthritis
Which joints are primarily affected by pauciarticular arthritis?
Large joints, particularly the knees, and less often the ankles and wrists.
p.18
Developmental Dysplasia of the Hip (DDH)
What is the incidence of DDH?
Common, with an incidence greater than 1%.
p.18
Developmental Dysplasia of the Hip (DDH)
What spectrum of diseases does DDH encompass?
Acetabular dysplasia, subluxation, and dislocation.
p.44
Juvenile Idiopathic Arthritis
When are steroids used in management?
For pain control and inflammation suppression.
How can juvenile idiopathic arthritis contribute to limping?
It causes joint inflammation, leading to pain and difficulty walking.
p.37
Slipped Upper Femoral Epiphysis (SUFE)
When should the other normal side be prophylactically fixed in SUFE?
If the patient is an obese male teen, hypothyroid, very young at first slip (<10 years old), or at risk of neglecting follow-up.
p.22
Developmental Dysplasia of the Hip (DDH)
What does the acetabular index show in DDH?
If the acetabulum is dysplastic.
When is operative management indicated in osteomyelitis?
For subperiosteal abscess formation.
p.10
Septic Arthritis in Children
What age group is most affected by Septic Arthritis of the hip?
Over 50% of patients are under 2 years of age.
p.1
Common Paediatric Pathologies
What is the focus of a Paediatric Orthopaedics Clinical Lecturer?
Teaching and researching trauma and orthopaedic surgery in children.
p.36
Slipped Upper Femoral Epiphysis (SUFE)
What does it indicate if Klein's line does not intersect the epiphysis on an AP X-ray?
It may suggest a slipped upper femoral epiphysis.
p.43
Juvenile Idiopathic Arthritis
What is a complication associated with chronic inflammation in the body?
Chronic anterior uveitis.
p.2
Common Paediatric Pathologies
What skill is necessary for diagnosing paediatric pathology?
Developing diagnostic skills specific to paediatric conditions.
How does varus femoral osteotomy affect the hip joint?
It alters the angle of the femur to enhance stability and blood supply to the femoral head.
What are common causes of osteomyelitis?
Bacterial infections, often from open fractures or surgery.
How is the severity of Perthes Disease commonly graded?
Radiologically using X-ray grading systems.
What are the most commonly used grading systems for Perthes Disease?
Catterall, Herring, and Waldenstrom systems.
p.33
Slipped Upper Femoral Epiphysis (SUFE)
What are some risk factors for SUFE?
Obesity, hormonal abnormalities (hypothyroid, raised GH, reduced sex steroids), and previous radiation.
How is osteomyelitis diagnosed?
Through imaging studies and laboratory tests.
Why is it important not to overlook a limping child?
Because of potentially devastating complications.
What is the typical treatment for osteomyelitis?
Antibiotics and sometimes surgery to remove infected tissue.
p.41
Juvenile Idiopathic Arthritis
What are common presenting complaints (P/C) of Still's Disease?
Acute illness, high spiking fever, anorexia/weight loss, salmon pink rash, aches and pains in joints/muscles, hepatosplenomegaly, lymphadenopathy.
How is limping in children generally categorized?
By anatomical location of pathology and age of onset.
p.41
Juvenile Idiopathic Arthritis
What blood findings are associated with Still's Disease?
Anaemia, high white cell count (WCC), elevated platelets, CRP, and ESR.
p.3
Common Paediatric Pathologies
What is the primary characteristic of common paediatric pathologies?
They are health issues frequently observed in children.
What are the symptoms of osteomyelitis?
Pain, swelling, fever, and redness over the affected area.
What is Perthes Disease?
Idiopathic avascular necrosis (AVN) of the immature femoral head.
What are common hip causes for babies and toddlers?
Developmental Dysplasia of the Hip (DDH) and septic arthritis.
p.24
Developmental Dysplasia of the Hip (DDH)
What position should the hip be in when using a Pavlik harness?
Hip flexed and abducted to 90 degrees.
What type of gait disturbance is associated with Perthes Disease?
Antalgic limp and Trendelenburg gait.
p.18
Developmental Dysplasia of the Hip (DDH)
What does DDH stand for?
Developmental Dysplasia of the Hip.
p.4
Genu Varum and Genu Valgum
At what age is Genu Varum most common?
In toddlers under 3 years of age.
p.3
Common Paediatric Pathologies
What role do vaccinations play in preventing common paediatric pathologies?
They help protect children from infectious diseases.
What condition is associated with Perthes Disease in 1/3 of cases?
ADHD (Attention Deficit Hyperactivity Disorder).
p.39
Juvenile Idiopathic Arthritis
What defines polyarticular Juvenile Idiopathic Arthritis?
Involvement of more than 5 joints.
What role does developmental dysplasia of the hip play in limping?
It can cause instability and pain in the hip joint, leading to a limp.
p.34
Slipped Upper Femoral Epiphysis (SUFE)
What physical examination findings are associated with SUFE?
Reduced abduction/internally rotated hip and Trendelenburg sign.
p.13
Transient Synovitis of the Hip
What are the main characteristics of transient synovitis of the hip?
Inflammation and hypertrophy of hip synovium, with or without joint effusion.
p.13
Transient Synovitis of the Hip
What common associations are linked to transient synovitis of the hip?
Upper respiratory tract infection (URTI), trauma, and atopy (e.g., asthma).
What age group is most commonly affected by Perthes Disease?
Children between the ages of 4 and 10.
What is Gage's sign associated with?
Late-stage Perthes Disease.
What is the most common site for osteomyelitis?
Distal femur and proximal tibia.
p.32
Slipped Upper Femoral Epiphysis (SUFE)
What are common symptoms of SUFE?
Hip pain, limited range of motion, and a limp.
p.32
Slipped Upper Femoral Epiphysis (SUFE)
How is SUFE diagnosed?
Through physical examination and imaging studies like X-rays.
p.33
Slipped Upper Femoral Epiphysis (SUFE)
What is Slipped Upper Femoral Epiphysis (SUFE)?
A disorder of the growth plate where there is slippage of the epiphysis relative to the femoral neck.
What is the main goal of surgical intervention in Perthes disease?
To prevent deformity and maintain hip function.
p.40
Juvenile Idiopathic Arthritis
What is the gender prevalence for polyarticular Juvenile Idiopathic Arthritis?
More common in females than males (F>M).
p.40
Juvenile Idiopathic Arthritis
At what ages can polyarticular Juvenile Idiopathic Arthritis occur?
It can occur at all ages.
p.11
Septic Arthritis in Children
What are the initial treatment steps for septic arthritis?
Blood cultures and IV antibiotics (initially broad spectrum), aspiration of joint under U/S guidance.
p.3
Common Paediatric Pathologies
How do common paediatric pathologies typically present?
With symptoms that may vary based on age and development.
p.17
Developmental Dysplasia of the Hip (DDH)
What does DDH stand for?
Developmental Dysplasia of the Hip.
p.39
Juvenile Idiopathic Arthritis
What is Juvenile Idiopathic Arthritis?
A group of conditions with chronic arthritis lasting more than 6 weeks, presenting before 16 years of age.
What is a common cause of a limp in children?
Injury or trauma to the leg or foot.
p.34
Slipped Upper Femoral Epiphysis (SUFE)
What is a common clinical presentation of Slipped Upper Femoral Epiphysis (SUFE)?
Vague hip/groin/thigh pain or isolated knee pain.
p.39
Juvenile Idiopathic Arthritis
What defines pauci/oligoarticular Juvenile Idiopathic Arthritis?
Involvement of less than 5 joints.
p.18
Developmental Dysplasia of the Hip (DDH)
What is a 'Teratologic Hip'?
A fixed irreducible hip associated with conditions like spina bifida, arthrogryposis, and Ehlers-Danlos.
What is a potential cause of a limp related to bone growth?
Conditions like Perthes disease can affect hip joint development.
p.25
Developmental Dysplasia of the Hip (DDH)
What is the management approach for DDH in children older than 18 months?
Open reduction and osteotomy, ideally femoral, but pelvic osteotomy may be necessary.
p.22
Developmental Dysplasia of the Hip (DDH)
What does Perkin's line indicate in DDH imaging?
Whether the hip is subluxed or dislocated.
p.34
Slipped Upper Femoral Epiphysis (SUFE)
What imaging is used in the workup of SUFE?
X-rays showing Klein's line, Steel sign, and widened physis.
What are the common symptoms of Perthes Disease?
Hip pain, limping, and reduced range of motion in the hip.
p.13
Transient Synovitis of the Hip
What is the conservative management for transient synovitis of the hip?
NSAIDs, bed rest, and partial weight bearing (PWB) for 6 weeks.
p.20
Developmental Dysplasia of the Hip (DDH)
What does Barlow's test assess?
It tests for a dislocated hip.
What is osteomyelitis?
An infection of the metaphysis of long bones.
p.20
Developmental Dysplasia of the Hip (DDH)
What physical sign indicates DDH related to thigh folds?
Asymmetrical thigh folds.
p.35
Slipped Upper Femoral Epiphysis (SUFE)
What are common symptoms of SUFE?
Hip pain, limited range of motion, and a limp.
p.35
Slipped Upper Femoral Epiphysis (SUFE)
How is SUFE diagnosed?
Through physical examination and imaging studies like X-rays.
What is Juvenile Idiopathic Arthritis?
An autoimmune condition that can cause joint pain and limping in children.
p.11
Septic Arthritis in Children
What are the Kocher criteria for septic arthritis of the hip?
WCC > 12, ESR > 40, refusal to weight bear, high fever (>38.5).
What management is often required for late Perthes Disease?
Bed rest, traction, abduction splinting, and sometimes femoral/pelvic osteotomy.
p.24
Developmental Dysplasia of the Hip (DDH)
What is the recommended treatment for DDH in children aged 0-6 months?
Pavlik harness for 6 weeks.
p.42
Juvenile Idiopathic Arthritis
What is pauciarticular or oligoarthritis?
A form of juvenile idiopathic arthritis (JIA) that usually occurs in young children.
p.38
Juvenile Idiopathic Arthritis
What are other inflammatory conditions?
Conditions that involve inflammation but are not classified under specific categories like arthritis or autoimmune diseases.
What are some risk factors associated with Perthes Disease?
Low birth weight, positive family history, abnormal birth presentation, second-hand smoke, and descent from Asian, Inuit, or Central European backgrounds.
p.17
Developmental Dysplasia of the Hip (DDH)
At what age is DDH most commonly diagnosed?
In infants and young children.
p.38
Juvenile Idiopathic Arthritis
What role does the immune system play in inflammatory conditions?
It mistakenly attacks healthy tissues, causing inflammation.
p.17
Developmental Dysplasia of the Hip (DDH)
What are the potential consequences of untreated DDH?
Hip pain, arthritis, and impaired mobility.
p.34
Slipped Upper Femoral Epiphysis (SUFE)
Is Slipped Upper Femoral Epiphysis usually traumatic or atraumatic?
Most commonly atraumatic, but some cases present after an injury.
p.37
Slipped Upper Femoral Epiphysis (SUFE)
What is the management approach if there is less than 30% slippage in SUFE?
Reduction is not necessary; just fixate with a single screw.
p.37
Slipped Upper Femoral Epiphysis (SUFE)
What should be done if there is more than 30% slippage in SUFE?
Must reduce first, then internally fixate; corrective osteotomy may be needed.
What indicates late-stage Perthes Disease on an X-ray?
Calcification lateral to the epiphysis.
What change occurs to the physis in late Perthes Disease?
The physis becomes horizontal.
What is the long-term outlook for children with Perthes Disease?
Most children recover fully, but some may experience complications like hip arthritis later in life.
p.20
Developmental Dysplasia of the Hip (DDH)
What is the Galeazzi sign used for?
It is used to assess for hip dislocation.
p.35
Slipped Upper Femoral Epiphysis (SUFE)
What age group is most commonly affected by SUFE?
Typically occurs in adolescents, usually between ages 10 and 16.
What blood tests indicate osteomyelitis?
Increased WCC, CRP, ESR, and positive blood cultures.
p.11
Septic Arthritis in Children
What is the progression of septic arthritis if untreated?
SIRS → sepsis → severe sepsis → septic shock.
What is a common physical exam finding in Perthes Disease?
Hip stiffness with loss of internal rotation and abduction.
p.44
Juvenile Idiopathic Arthritis
What type of team is involved in the management of the condition?
A multidisciplinary team.
p.3
Common Paediatric Pathologies
Why is early diagnosis important in common paediatric pathologies?
To ensure timely treatment and better health outcomes.
p.44
Juvenile Idiopathic Arthritis
What is required daily for management?
Daily exercise, with or without splints.
p.39
Juvenile Idiopathic Arthritis
How is Juvenile Idiopathic Arthritis classified?
According to onset as systemic, polyarticular (>5 joints), and pauci/oligoarticular (<5 joints).
p.42
Juvenile Idiopathic Arthritis
What type of medical exams are required for children with pauciarticular arthritis?
Frequent ophthalmologic exams.
How can infections lead to a limp?
Infections like septic arthritis or osteomyelitis can cause pain and swelling.
p.5
Genu Varum and Genu Valgum
What is the typical stance of a person with Genu Valgum?
Feet are wide apart while knees are together.
p.25
Developmental Dysplasia of the Hip (DDH)
What is the management approach for Developmental Dysplasia of the Hip (DDH) in children aged 6 to 18 months or those with a failed Pavlik harness?
Closed reduction (or open reduction if closed not possible) followed by hip spica cast.
p.44
Juvenile Idiopathic Arthritis
What types of surgeries may be indicated?
Arthrodesis and arthroplasty.
p.25
Developmental Dysplasia of the Hip (DDH)
What types of osteotomies may be performed for DDH?
Salter osteotomy, Chiari osteotomy, Ganz osteotomy, and Steel osteotomy.
p.13
Transient Synovitis of the Hip
How does transient synovitis of the hip differ from septic arthritis?
In transient synovitis, the child can usually walk, is not febrile, and has normal blood tests.
p.22
Developmental Dysplasia of the Hip (DDH)
What symptoms may indicate milder DDH in young children?
Delayed walking, leg length discrepancy, limited range of motion.
p.22
Developmental Dysplasia of the Hip (DDH)
What symptoms may indicate DDH in older children?
Limp and Trendelenberg gait.
What does operative management of osteomyelitis include?
Surgical drainage, debridement, and IV antibiotics.
What are some complications of osteomyelitis?
Septic arthritis, meningitis, growth disturbances, pathologic fractures, DVT.
What is a common developmental condition that can cause limping in children?
Developmental Dysplasia of the Hip (DDH).
What is Slipped Upper Femoral Epiphysis (SUFE)?
A condition where the femoral head slips off the neck of the femur, causing limping.
p.41
Juvenile Idiopathic Arthritis
What is the prognosis for children with Still's Disease?
Poor prognosis; some recover well while others may develop chronic arthritis and polyarthritis.
p.40
Juvenile Idiopathic Arthritis
Which joints are most commonly affected in polyarticular Juvenile Idiopathic Arthritis?
Wrist, hands, knees, and ankles, often symmetrically.
What leads to the Trendelenburg gait in Perthes Disease?
Head collapse leads to decreased tension of abductors.
p.17
Developmental Dysplasia of the Hip (DDH)
What is the primary issue in Developmental Dysplasia of the Hip?
Improper formation of the hip joint.
p.4
Genu Varum and Genu Valgum
What are two potential causes of Genu Varum?
Rickets and Blount’s disease.
p.38
Juvenile Idiopathic Arthritis
How can inflammatory conditions affect children?
They can lead to joint pain, mobility issues, and growth problems.
p.44
Juvenile Idiopathic Arthritis
Name some DMARDs used in management.
Methotrexate, Etanercept, Rituximab, Azathioprine.
p.4
Genu Varum and Genu Valgum
When might surgical treatment be required for Genu Varum?
If conservative treatment is not effective, an osteotomy may be performed.
p.44
Juvenile Idiopathic Arthritis
Under what circumstances might surgery be needed?
In cases of extreme deformities or severe disease.
p.5
Genu Varum and Genu Valgum
What age group is most commonly affected by Genu Valgum?
Between 2 to 7 years of age.
p.5
Genu Varum and Genu Valgum
What is the primary method of managing Genu Valgum?
Observation, with bracing rarely used.
What is Perthes Disease?
A childhood condition affecting the hip joint, where the blood supply to the femoral head is temporarily disrupted.
What is the primary treatment for Perthes Disease?
Treatment often involves rest, physical therapy, and sometimes the use of braces or surgery.
When is non-operative management indicated in osteomyelitis?
Early disease without abscess formation.
p.35
Slipped Upper Femoral Epiphysis (SUFE)
What is Slipped Upper Femoral Epiphysis (SUFE)?
A condition where the head of the femur slips off the neck of the femur at the growth plate.
p.32
Slipped Upper Femoral Epiphysis (SUFE)
What is Slipped Upper Femoral Epiphysis (SUFE)?
A condition where the head of the femur slips off the neck of the bone at the growth plate.
p.32
Slipped Upper Femoral Epiphysis (SUFE)
What is a potential complication of untreated SUFE?
Avascular necrosis of the femoral head.
What do X-rays show in the early stages of osteomyelitis?
Initially normal other than soft tissue swelling.
What conditions are common in young children that cause limping?
Septic arthritis, Perthes disease, transient synovitis of the hip, and DDH.
p.11
Septic Arthritis in Children
What is the urgent surgical intervention required for septic arthritis?
Incision and drainage followed by IV antibiotics.
p.40
Juvenile Idiopathic Arthritis
How does the pattern of disease in polyarticular Juvenile Idiopathic Arthritis compare to adult rheumatoid arthritis?
It is similar to adult rheumatoid arthritis.
p.38
Juvenile Idiopathic Arthritis
What is a common symptom of inflammatory conditions?
Swelling, pain, and redness in affected areas.
What is the natural history of Perthes Disease?
Spontaneous resolution, but increases the risk of secondary osteoarthritis 10-fold.
p.37
Slipped Upper Femoral Epiphysis (SUFE)
What is the primary management required for Slipped Upper Femoral Epiphysis (SUFE)?
Surgery is almost always required due to the risk of progression.
p.38
Juvenile Idiopathic Arthritis
What are some treatment options for inflammatory conditions?
Medications, physical therapy, and lifestyle changes.
p.22
Developmental Dysplasia of the Hip (DDH)
What does Hilgenreiner's line indicate in DDH imaging?
Whether the hip is subluxed or dislocated.
p.34
Slipped Upper Femoral Epiphysis (SUFE)
What can delayed diagnosis of SUFE lead to?
Deformity and increased risk of secondary osteoarthritis (OA).
What is a common cause of limping in toddlers?
Transient synovitis of the hip, which causes temporary hip pain.
p.13
Transient Synovitis of the Hip
What is the typical course of transient synovitis of the hip?
Self-limiting disease with rapid improvement within 24-48 hours and full resolution within a week.
What are the two management approaches for osteomyelitis?
Operative and non-operative.
What are the presenting complaints of osteomyelitis?
Painful, immobile limb with acute febrile illness.
What is Perthes Disease?
A condition that affects blood supply to the hip joint, leading to limping.
p.18
Developmental Dysplasia of the Hip (DDH)
What causes DDH?
Abnormal development of the hip due to laxity of its capsule and mechanical instability.
p.17
Developmental Dysplasia of the Hip (DDH)
What are common risk factors for DDH?
Family history, breech birth, and female gender.
What are the stages of Perthes Disease according to Waldenstrom?
Initial (infarction), Fragmentation (collapse of femoral head), Re-ossification, Remodeling.
p.37
Slipped Upper Femoral Epiphysis (SUFE)
What is a potential risk associated with surgery for SUFE?
Avascular necrosis (AVN).
What is the early X-ray feature of Perthes Disease?
Crescent sign (subchondral fracture).
p.5
Genu Varum and Genu Valgum
What surgical procedure may be needed if Genu Valgum does not improve?
Corrective surgery (osteotomy).
How is Perthes Disease diagnosed?
Through physical examination and imaging studies like X-rays or MRI.
p.20
Developmental Dysplasia of the Hip (DDH)
What should be done for all babies at birth regarding DDH?
They must be examined for DDH.
What does non-operative management of osteomyelitis typically involve?
IV antibiotics alone with prolonged oral switch.
p.20
Developmental Dysplasia of the Hip (DDH)
What does the Ortolani test evaluate?
It evaluates a reduced dislocated or unstable hip.
What is the usual cause of osteomyelitis?
Haematogenous spread of pathogens such as Staphylococcus aureus, Streptococcus, and HACEK.
p.32
Slipped Upper Femoral Epiphysis (SUFE)
What age group is most commonly affected by SUFE?
Typically adolescents, especially those aged 10 to 16 years.
What are the signs of osteomyelitis?
Swelling, tenderness, erythema, warmth, decreased movement of the limb.
p.32
Slipped Upper Femoral Epiphysis (SUFE)
What is the primary treatment for SUFE?
Surgical fixation of the femoral head.
p.35
Slipped Upper Femoral Epiphysis (SUFE)
What is a potential complication of untreated SUFE?
Avascular necrosis of the femoral head.
p.35
Slipped Upper Femoral Epiphysis (SUFE)
What is the primary treatment for SUFE?
Surgical fixation of the femoral head.
