Armando Hasudungan
Biology and Medicine videos

Paediatric Orthopaedics

Osteochondroses

Osteochondroses is a condition that affects the epiphysis of bones. Pathology consists of localised area of ischaemic bone necrosis and oedema of adjacent soft tissue.

Remember Osteochondroses result in avascular necrosis of the epiphyseal bone, similar to Perthes disease, but less common. In general osteochondroses is more troublesome than serious.

Age effects usually 10-15 +/-


Clinical Feature Ache and muscle spasm +/- pain


Diagnosis Clinical + X-ray


Management Usually self-resolving (except slipped capital femoral epiphysis). Manage with streatching and NSAIDs


 

TYPES OF OSTEOCONDRITIDES
Osteochonroses Features Treatment
Scheuermann’s Condition Increased kyphoses and mid/low thoracic back pain Observe, reassurance, encourage exercise and standing straight. Physiotherapy can help.
Chondromalacia patellae Pain in the knee or distal thigh and a limp Resolves within 1-2 years. Quadricep stretch recommended
Osgood Sclatter condition Pain and swelling over tibial tuberosity exacerbated by jumping or diret pressure (kneeling) Resolves within 1-1.5 years. Quadricep stretch recommended
Sever Condition Posterior heel pain with activity and shoe wear Resolves 1 year. Calf stretch recommended

Bow Legs vs. Knock knees

Normal development
Varus (birth-24 months)
Neutral (18-24 months)
Valgus (4-7 years)
Neutral/Slight Vulgus (7- adults)

 

Knock Knees (Venu Valrum)  Bow Legs (Genu Varum)
Feature Angular deformity at the knee where the apex of the deformity points toward the midline  Angular deformity at the knee where the apex of the deformity points away from the midline
Physiologic normal Between ages 2-7 yo  <2 y0
Investigate <2years or >7years. Unilateral an/or symptomatic  > 2 years. Unilateral, gait abnormalities
Pathological Fractures especially physeal fractures, rickets, skeletal dysplasia, neoplasms Blount disease (cartilage disorder), rickets, skeletal dysplasia, trauma, infection, neoplasm
Treatment Surgery usually required or treatment for systemic conditions Surgery usually required or treatment for systemic conditions

Painful/Problamtic Hips

Overview Hip pain and problems are common in children and are caused by a variety of things. Children may present with knee pain, but actually hip problem in origin. This is due to referred pain from the hip to the knee, which is common.

COMMON CAUES OF HIP PAIN IN CHILDREN
Condition Features Treatment
Transient synovitis of the hip Cheif cause of hip pain in children. It is usually diagnosed by exclusion. Observation, rest and analgesia
Perthes’ disesae 3-11 yo. Osteochondritis of the femoral head, secondary to avascular necrosis of the developing femoral head. More common in males (4:1), bilateral 15%. Monitor, early arthritis. Surgery is inevitable
Slipped capital femoral epiphysis 10-16 yo. Limp, usually in an overweight child (50%), commonly in males (3:1), bilateral 20%. The affected limb will be shorter and lies in external rotation. abduction is limited when hip is flexed and internally rotated Surgery with screw fixation across the physis to prevent furtehr slip
Tubercular arthritis 2-5yo and the elderly. Rare condition. All hip movements cause pain and hip spasm Rest. Anti-tuberculosis drugs. +/- Arthrodesis

Developmental Hip Dysplasia

More info on Congenital Hip Dysplasia

Idopathic scoliosis

Definition
Scoliosis: lateral curvature of the spine (>10º of curvature). Typically accompanied by a degree of spinal column rotation.
Idiopathic scoliosis: scoliosis with no definite etiology unlike neuromuscular, congenital, or syndromic types.

Overview 80-85% of cases occur in adolescents (children over 10 years of age)

Investigations

PA standing spine radiograph

  • Assess cobb angle (measure magnitude)
  • Assess skeletal maturity
  • Evaluate etiology: congenital, neuromuscular, idiopathic

Management depends on degree of severity

  • Observation: for patient with a Cobb angle of less than 20º
    • Clinical examination and plain x-ray until skeletal maturity is reach or curve progresses to require bracing
  • Bracing: for curvature greater than 20º but less than 50º
    • Generally a thoraco-lumbar- sacral orthosis is used for 13-18 hours each day
    • If brace is worn less 13 –  less successful outcome
  • Surgery: spinal fusion for curvature greater then 50º

Fractures

More to come

Remember Rules of 2’s for fracture: 2 views: AP and lateral, 2 joints: above and below- exclude dislocation, 2 times: ensure fracture not shifted after 1 week, 2 sides: contralateral side for comparison