Paeds orthopaedics

Dr Alan Shortt

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Exclude common easy misses painful shoe verucca or groin lymphadeopthy
Remember hip pain can refer to knee and vice versa.
All children need same day referral for Xray/ultrasound.

Child with a limp
0-5	CDH Irritible hip
5-10	Perthes
10-15	SUFE
Any Age	Trauma/Osteomyelitis/Septic arhritis (inc TB)/Stills Disease /Rickets/Leukaemia/Haemophilia/SCD/Neurological Disease/JC

Irritible hip

Irritable hip Medscape

Slipped upper femoral epiphysis

SUFE / SCE

Suspect in child 9-12 yrs with painful limp.
An X-ray of hips in Abduction and Internal rotation may be necessary (Lowenstein View)
May need internal fixation.

Perthes

Osgood Schlatter

youtu.be/_ptw3duD2wM

Kyphosis and scoliosis

Scheuermans

Osteomyelitis in children

localized pain accompanied by a fever

Growing Pains

Common problem affecting 10-15% children aged 4-10 years. girls>boys.
Intermittent bilateral deep leg (calves & thigh) pain over several weeks and months particularly towards end of day/at night. Cause unknown but not in fact related to growth. Treatment = simple analgesia +/- massageand stretching.

Benign hypermobility syndrome in Kids
hacking-medschool/hypermobility
pains present in children with hypermobility
the pain occurs at the end of the day, but is localized to the joints and does not disrupt sleep.

Pulled elbow

Child < 5 not using arm after being swung by parents while walking or other traction injury May appear to follow a fall.
Radial head subluxes distally through a relatively lax annular ligament.
Child is miserable and arm held limply by side half flexed and pronated
Perform full exam to exclude fractures which can be easily missed in children -clavicle shoulder then forearm wrist and hand common sites for greenstick
Next shaft and distal humerus and gently flex and extend supported elbow to rule out supracondylar fractures

Hold the childs hand as if shaking hands. Supporting elbow at 90 degrees with your other hand push the childs hand proximaly while pronating and supinating simutaneously. Distinct click is felt chield shrieks but then uses arm within 5 mins. Allow home when he can put both hands on head or pick up sweet with injured arm

youtu.be/qRMA7s4uAJ4

Knock Knees

Severs

youtu.be/97KSvgipIW0

Club foot

Congenital abnormality = plantar flexion adduction and inversion of the foot with limited range of passive / stretch movement . refer early – if untreated can become fixed deformity.

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