- Fever - Tiredness - Erythema - Oedema - Fussiness / irritability - Lethargy

- affecting 1-4 joints in the first 6/12 - commonly affects the knee and ankle - assoc with other inflammation (uveitis)

- Male > Female Growth spurt age: - Boys 12-15 years - Grils 8-12 years - Active in sports which include running, jumping, and repetitive bending of the knee are at greater risk of developing the condition.

- Full avulsion fracture - Ossicles (bony fragments) formation in the knee - may impinge on the patellar tendon, causing pain and limiting activity

- Gradual onset of pain - Swelling below the knee - Pain relived on resting - Pain exacerbate by activities

- Tenderness over the tibial tuberosity that is provoked by knee extension against resistance - Firm or bony enlargement of the tibial tuberosity

- Rest - Ice - Analgesia / NSAIDs - Physios - Avoid aggrevating activities - Refer Paeds ortho for persistent Sx

- Widening of epiphyseal line or displacement of the femoral head - Klein's line does not intersect the femoral head

- Obesity - Endocrine disorders - Puberty: Girls 11-12 years Boys 12-13 years

MSK Flashcards by Kappi Lee

Define Slipped upper femoral epiphysis - SUFE

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

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SUFE imaging Ix

Bilateral X-ray: Anteropost and ‘frog leg’ lateral position

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Septic arthritis gold standard Ix

Aspiration of the joint: Gram staining, cell count, glucose level, crystal analysis cultures

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Osteomyelitis Risk Factors

Trauma from injury
bones growing more blood supply easier for bacteria to travel into the bone
Open bone fracture
Orthopaedic surgery
Immunocompromised
Sickle cell anaemia
HIV
Tuberculosis

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Osteomyelitis Sx

Fever
Tiredness
Erythema
Oedema
Fussiness / irritability
Lethargy

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Vit D deficiency Loading dose in Age 1–5 months

3000 IU daily for 8–12 weeks.

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Current guidance on vitamin d supplements in children under 5

0-1 year Vit. D RDI:
8.5-10mcg
1-4 years RDI Vit D RDI: 10 mcg

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When is vit D supplement not indicated for children

> 500ml of infant formula a day

Fortified with vit D

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Vit D deficieny risk factors

Low / no exposure to the sun
Dark skin tone
Exclusively breastfed babies
GI / malabsorption disorders: Coeliac, lactose intolerance, Cystic fibrosis
Insufficient maternal vit D
Premature baby

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Define Osgood-Schlatter Disease

An inflammation at the tibial tuberosity where the patella ligament inserts

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Oliogoarticular JIA

affecting 1-4 joints in the first 6/12
commonly affects the knee and ankle
assoc with other inflammation (uveitis)

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late stages of arthiriris

joint spaces narrowed and spaces fuse together

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RED FLAGS in children

Fever: Septic arthritis,
WL

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Osgood-Schlatter Disease presentation

Ant. knee pain
Pain is exacerbated by physical activity; running, jumping, and on extension of the knee
Visible or palpable hard and tender lump at the tibial tuberosity
Usually unilateral

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OSD pathophysiology

There are multiple small avulsion fractures, where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially this bump is tender due to the inflammation, but has the bone heals and the inflammation settles it becomes hard and non-tender.

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OSD Risk factors

Male > Female
Growth spurt age:
Boys 12-15 years
Grils 8-12 years
Active in sports which include running, jumping, and repetitive bending of the knee are at greater risk of developing the condition.

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OSD complications

Full avulsion fracture
Ossicles (bony fragments) formation in the knee - may impinge on the patellar tendon, causing pain and limiting activity

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OSD Sx

Gradual onset of pain
Swelling below the knee
Pain relived on resting
Pain exacerbate by activities

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OSD Dx

Tenderness over the tibial tuberosity that is provoked by knee extension against resistance
Firm or bony enlargement of the tibial tuberosity

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OSD Mx

Rest
Ice
Analgesia / NSAIDs
Physios
Avoid aggrevating activities
Refer Paeds ortho for persistent Sx

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SUFE X-ray findings

Widening of epiphyseal line or displacement of the femoral head
Klein’s line does not intersect the femoral head

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SUFE Acute presentation

< 3/52 of Sx onset
Painful limp
External rotation of the hip joint
length discrepency
unable to weight bear

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SUFE examination findings

External rotation of the hip
Leg length discrepency
Limited ROM on internal rotation and abduction of the hip

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SUFE Risk Factors

Obesity
Endocrine disorders
Puberty: Girls 11-12 years
Boys 12-13 years

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SUFE Mx

- Refer to paeds ortho **stat** - Avoid excessive movements / weight bear on the affected hip - Analgesia - **Surgically:** In situ single-screw fixation of the epiphysis

SUFE complications

Avascaular necrosis AKA Osteonecrosis

Septic arthritis diagnostic criteria in aspiration

WBC > 50,000

Septic arthritis diagnostic criteria for **prosthetic** in aspiration

WBC > 1100

Paed Septic arthritis presentations

- Acute presentation - unable to weight bear - Hot, swollen, painful, restricted joint - Fever (60% of cases) - Erythema - Swelling

Septic Arthritis examination findings

- Erythema - Effusion - Hot to touch - Pain on palpation - Fever - Systemically unwell

Septic arthritis aspiration fluid characteristics

- Purulent - Cloudy

Septic arthritis common causative organism

- Staph aureus

Septic arthritis Mx

- Empirical Abx until sensitivities - Abx for 6/52 from diagnosis - Surgical drainage and washout of the joint to clear the infection in severe cases

Osteomyelitis epidemiology

- < 5 years - long bones: arms / legs

Paeds Osteomyelitis common site

metaphysis of the long bones

Paeds Osteomyelitis common causative organism

Staph aureus

Acute Paeds osteomyelitis

Infection in the bone - over 2/52

Paeds osteomyelitis Ix

- **Bloods:** FBC, ESR, CRP - Blood culture: Before commencing Abx - X-rays - MRI - Bone scan

Paeds osteomyelitis Mx

1. **Admit** 2. Blood culture 3. Think **Sepsis**: IV Abx after blood culture / within 1h of presenting for high risk sepsis patient

Paeds osteomyelitis complications

- Sepsis - Osteonecrosis AKA AVN - Bone abscess - Septic arthritis - Chronic osteomyelitis

Paeds Septic arthritis complications

**Joint damage:** Septic arthritis can cause permanent damage to joints, including joint degeneration, stiffness, and dysfunction. **Osteomyelitis:** An infection of the bone itself **Osteonecrosis:** Bone tissue dies due to lack of blood flow **Sepsis:** A widespread inflammation in the body **Death:** In severe cases, septic arthritis can lead to death **Limb length discrepancy:** A difference in the length of one leg compared to the other

Vit D deficiency serum level in children

Serum 25-hydroxyvitamin D (25[OH]D) levels < 25 nmol/L

Vit D sufficient serum level in children

Serum 25-hydroxyvitamin D (25[OH]D) levels > 50 nmol/L

Vit D deficiency in children complications

- Rickets - Osteomalacia and muscle weakness - Hypocalcaemia: seizures - Dilated cardiomyopathy

Vit D deficiency Loading dose in Age 6-11 months

6000 IU daily for 8–12 weeks.

Vit D deficiency Loading dose in Age 12–18 years

- 10,000 IU daily for 8–12 weeks. - A single or divided oral dose totalling 300,000 IU can be considered if there is concern about compliance with treatment.

Vit D deficiancy daily maintenance dose in children post loading dose regime

400–600 IU daily for 1/12

Define Juvenile Idiopathic Arthritis (JIA)

A collective term used to describe arthritis that affects children and young individuals under the age of 16

Systemic JIA Sx

- Muscle / joint pain - High swinging fever 37-39 - WL - Salmon-pink rash

Systemic JIA presentations

- Lymphadenopathy - Serositis: inflammation to the serous membranes (pericarditis, pleuritis, peeritonistis) - Hepato / SPlenomeagly - Salmon-pink rash - High Temp

Systemic JIA ANA, RF findings

-ve

Systemic JIA inflammatory marker findings

Raised for CRP, ESR, PLTs, Ferritin

Systemic JIA complication

Macrophage activation syndrome (MAS) ## Footnote disseminated intravascular coagulation

Define Oligoarticular JIA AKA Pauciarticular JIA

Arthritis involving < 4 joints

Oligoarticular JIA Risk factors

- Female > Male - Age < 6years

Oligoarticular JIA extrarticular complication

Ant. uveitis

Oligoarticular JIA Sx

- Pain in joints - Swelling in joints - Morning stiffness **NO Systemic Sx**

Oligoarticular JIA auto-antibodies findings

- RF -ve - ANA +ve

Oligoarticular JIA Mx

- Refer to paed Rheum - **Intra-articular steroid injection**

Oligoarticular JIA commonly affects which joints

Large joints: knee and ankle

Define Polyarticular JIA

Idiopathic inflammatory arthritis in > 5 joints

Polyarticular JIA presentations

- can be Symmetrical inflammation - affects smaller joints e.g. hands - **Minimal** systemic Sx

Polyarticular JIA subtypes

- Seronegative: RF -ve - Seropositive: RF +ve

Polyarticular JIA seronegative prevalence

toddler - preschool age Female > Male

Polyarticular JIA seropositive prevalence

older children and adolescents

Define Juvenile Psoriatic Arthritis

seronegative (RF -ve) inflammatory arthritis associated with psoriasis

Juvenile Psoriatic Arthritis presentations

- **Plaques of psoriasis**on the skin - **Pitting of the nails** (nail pitting) - **Onycholysis**, separation of the nail from the nail bed - **Dactylitis** inflammation of the full finger - **Enthesitis**, inflammation of the entheses, which are the points of insertion of tendons into bone

Systemic JIA Mx

- Refer to paeds rheum - Physical activities - Physio - Oral steroid

JIA bloods Ix

- FBC, CRP, ESR, ANA, RF

JIA imaging Ix

- **X-rays:** to exclude trauma, osteomyelitis or malignancy - **Ultrasound:** can show joint fluid, synovial hypertrophy and erosions if present - **MRI:** delineates any bony changes, joint damage and extent of synovitis

JIA X-ray findings

- Bone erosion - Narrowing of joint space - Fusion of bones

Chronic JIA complications

- Growth failure or abnormality - Osteoporosis - Delayed puberty

MSK Flashcards

(72 cards)