Orthopaedic

Question 1

most common age for transient synovitis

Answer 1

3-8 years

Question 2

mechanism of action for a supracondylar #

Answer 2

FOOSH with hyperextension at the elbow

Question 3

which deformity can result from an incorrectly managed supraconylar #

Answer 3

cubits varus

Question 4

most common Dx of limp in:

• Pre-school
• primary school
• adolescence

Answer 4

preschool - transient synovitis
primary school - Perthes disease
adolescence - SUFE

Question 5

asymmetrical pigeon toeing is indicative of

Answer 5

a spiral fracture in toddlers

Question 6

which conditions MUST you rule out in a children with a limp

Answer 6

malignancy
infection - septic arthritis/osteomyelitis
NAI

Question 7

complications of no treatment of DDH

Answer 7

pain
early high OA
limp
difficulty walking

Question 8

when should tests on the hips be performed in children

Answer 8

birth
1,2,4, 8 weeks
4, 8 months

Question 9

how do you diagnose SUFE

Answer 9

XRay

Question 10

what are the tests used for looking for DDH in a child >4 weeks

Answer 10

• decreased abduction
• skin creases
• thigh length discrepancy
• Knee height discrepancy

Question 11

empirical AB choice for septic arthritis/osteomyelitis

Answer 11

Flucloxacillin

Question 12

risk factors for DDH

Answer 12

• breach delivery
• oligohydramnios
• C. section
• FHx
• Congenital abnormalities (especially foot abnormalities)
• first-born
• female
• large baby

Question 13

clinical presentation of transient synovitis

Answer 13

• limp
• unilateral hip or groin pain
• history of recent URTI
• otherwise well child

Question 14

clinical presentation of perthes disease

Answer 14

• limp, especially after exercise

- mild or intermittent pain in anterior thigh (but classically described as a painless limp)

Question 15

treatment of a Toddler’s fracture

Answer 15

needs to treatment - heals spontaneously

Question 16

what is perthes disease

Answer 16

idiopathic avascular necrosis of the capital femoral epiphysis resulting from compromise of the blood supply

Question 17

what causes DDH

Answer 17

failure of the hip joint to develop normally –> dislocation of the hip

Question 18

most common mechanism of action leading to a Monteggia fracture-dislocation

Answer 18

FOOSH with hyperpronation or hyperextension of the forearm

Question 19

fancy name for flat feet

Answer 19

pes planus

Question 20

what is transient synovitis

Answer 20

transient inflammation of the synovium of the hip

Question 21

what are the tests used for looking for DDH in a child

Answer 21

Barlow - (downwards)

Otolani - (abduction)

Question 22

DDx for limping/non-weight bearing child of age 1-4

Answer 22

DDH
toddler’s #
Transient synovitis of the hip - most common
child abuse

Question 23

how long is the typical oral AB course for septic arthritis/osteomyelitis (after completion of IV therapy)

Answer 23

3 weeks if uncomplicated

Question 24

what is sitting in a W position indicative of

Answer 24

inset hips

Question 25

common risk factors for SUFE

Answer 25

- OBESITY - boys>girls - L>R

Question 26

most common bacterial causes of septic arthritis/osteomyelitis

Answer 26

staph aureus group A b-haemolytic strep haemophilus influenza

Question 27

DDx for limping/non-weight bearing child of age 4-10 years

Answer 27

transient synovitis of the hip | Perthes disease

Question 28

treatment of transient synovitis

Answer 28

heat and massage | ibuprofen

Question 29

what is the difference in pain onset between osteomyelitis and septic arthritis

Answer 29

osteomyelitis is usually a subacute onset, whereas SA is acute

Question 30

what is a Toddler's fracture

Answer 30

type of # of the tibial shaft that occurs in young ambulatory children - spiral or oblique undisplaced # of the distal shaft of the tibia with an intact fibula

Question 31

common age of patients with SUFE

Answer 31

late childhood/early adolescence

Question 32

what is the difference between a greenstick fracture and a torus fracture

Answer 32

greenstick - fracture is on the outside corner of the bend | torus - fracture is on the inside corner of the bend

Question 33

mechanism of action of a Toddler's fracture

Answer 33

twisting injury

Question 34

what does SUFE stand for

Answer 34

slipped upper femoral epiphysis

Question 35

what is the tip toe test

Answer 35

- diagnoses flat feet | - when child on tip toes, the long flexor and extensor muscles are recruited in the foot and an arch appears

Question 36

what signs on examination point you towards transient synovitis

Answer 36

- decreased range of hip movement - especially internal rotation - may be tender to palpation

Question 37

age range for perthes disease

Answer 37

2-12 | majority 4-8

Question 38

principles of management of perthes disease

Answer 38

minimal weight bearing and protection of the joint (maintain the femur abducted and internally rotated using a brace or surgery

Question 39

what signs on examination point you towards perthes disease

Answer 39

- restricted hip motion, especially in abduction and internal rotation - proximal thigh atrophy

Question 40

DDx for limping/non-weight bearing child of age >10

Answer 40

- slipped upper femoral epiphysis | - overuse syndromes/stress fractures

Question 41

diagnosis of DDH is done by which imaging

Answer 41

US - if 6 months

Question 42

management of DDH

Answer 42

- abduction splint - worn until the dysplastic acetabulum is radiologically and clinically normal - surgery may be needed in a child who is diagnosed later in life

Question 43

what causes Volkmann's ischaemic contracture and what is a common # it results from

Answer 43

disruption to the brachial artery --> necrosis of the muscles of the forearm - commonly results from a supracondylar # with forward displacement of the metaphysis

Question 44

pathological causes of flat feet

Answer 44

hypermobility syndromes | CP

Question 45

principles of management of SUFE

Answer 45

SURGERY - immediate internal fixation in-situ

Question 46

what features on examination point you towards SUFE

Answer 46

- hip appears externally rotated and shortened | - decreased hip movement, especially internal rotation

Question 47

potential complications of untreated SUFE

Answer 47

chondrolysis of the hip | avascular necrosis