Overview

• Osteochondritis Dissecans ⇒
  • Caused by disrupted blood supply to cartilage within the knee joint. A fragment of bone in the knee joint that becomes detached due to a lack of blood supply.
  • Sx → subacute onset of knee pain, swelling and locking, typically after exercise.
    • Signs O/E → joint effusion, tenderness on palpation of the articular cartilage of the medial femoral condyle (tenderness at this location).
• Perthes Disease ⇒

  • Degenerative disease affecting hip joints, typically in children 4-8 years old. Due to avascular necrosis of the femoral head.

  • 5 times more common in boys.

  • Sx → hip pain (progressively worsening over a few weeks), limb shortening, limp, reduced ROM.

    <aside> 💡 Similar presentation to SUFE. SUFE however presents more acutely following trauma. Perthes in primary school boys (4-8yo), whereas SUFE in secondary school (10-15yo)

    </aside>

  • Ix → plain x-ray (bilateral AP and frog-leg) +/- MRI (early stages may not show up on x-ray).

    • XR will show decrease in the size and opacity of the epiphysis in early stages, and flattening, fragmentation, and sclerosis later on.

  • Mx → self-limiting condition. Supportive care and physical therapy. If >6yo and conservative approaches haven’t worked, consider surgery.

• Osgood-Schlatter Disease ⇒
  • Inflammation at the tibial tuberosity where the patella ligament inserts. Typically occurs 10-15 years old.
  • Sx → visible/palpable lump and swelling at the tibial tuberosity, pain in anterior knee, pain exacerbated by physical activity and relieved by rest.
  • Mx →
    • Pain Relief → analgesia, apply ice pack over tibial tuberosity. (NSAIDS + RICE = rest, ice, compress, elevate).
    • Reassure that stopping all physical activity is not necessary.
  • Prognosis → usually resolves over time. Rare complication is avulsion fracture (requires surgical intervention).
• Transient Synovitis ⇒
  • Acute hip pain following recent viral infection. Typical age group 3-8 years.
    • Temporary inflammation of the synovial membrane in the joint commonly preceded by a viral upper respiratory tract infection.
  • Sx → limp/refusal to weight bear, groin/hip pain, low-grade fever (if high-grade, may indicate septic arthritis).
  • Mx → self-limiting (rest + analgesia). Any child with a limp + fever needs to be referred for same day assessment.
    • All children <3yo presenting with acute limp → urgent paediatric assessment. (Transient synovitis common in >3yo - SEPTIC ARTHRITIS MORE COMMON IN <3YO).
• Chondromalacia Patellae ⇒
  • Softening of the cartilage of the patella. Common in teenage girls.
  • Sx → anterior knee pain on walking up and down stairs and rising from prolonged sitting.
    • Grating Sensation.
  • Mx → rest, physiotherapy, and NSAIDs.

Making Diagnosis

Clinical Features

Investigations

Management Plan

Complications →

Prognosis →