7 bones and joints Flashcards
causes of genu varum (bowleg)
metabolic bone disease,
asymmetric growth arrest,
bone dysplasia and congenital and neuromuscular disorder
causes of genu valgum (knock knees)
metabolic bone disease, skeletal dysplasia, posttraumatic physeal arrest, tumors, infection
pain over the tibial tubercle in a growing child
Osgood-Schlatter Disease
- traction apophysitis of the tibial tubercle growth plate and the adjacent patellar tendon
- more common in males, athletes, 10-15 years old
abnormal morphology and development of the acetabulum
Acetabular dysplasia
partial contact between the femoral head and acetabulum
Hip sublaxation
hip with no contact between the articulating surfaces of the hip
Hip dislocation
-assess potential for dislocation of the non-displaced hip
-adducts Flexed hip and gently pushes the thigh
posteriorly in an effort to dislocate the femoral head
-(+) test: hip will slide out of the acetabulum
Barlow provocative maneuver
-attempt to reduce a dislocated hip
-grasp thigh between the thumb and Index finger and
with the 4th and 5th fingers, lift the greater trochanter
while simultaneously abducting the hip
-(+) test: femoral head will slip Into the socket with
Ortolani test (Reverse of Barlow)
- femoral head disorder of unkown etiology
- temporary interruption of the blood supply to the
bony nucleus of the proximal femoral epiphysis,
leading to impairment of the epiphyseal growth and femoral head deformity
Legg Calve Perthes Disease
-delayed skeletal maturation, shorter than normal
-most common symptom: limp of varying duration
-pain is activity related, localized
-antalgic galt after strenuous activity
-limited hip motion, atrophy of thigh muscles, calf,
buttocks secondary to pain
-classic portrait: small, thin, extremely active child
-plain radiographs: primary imaging tool
Goal of treatment:
create a spherical, well covered femoral head with hip range of motion close to normal
most common organism in all age groups of osteomyelitis
S.aureus
most common organism in 6y/o osteomyelitis
most cases are caused by S. aureus, Streptococcus, or Pseudomonas aeruginosa
second most common cause of osteomyelitis in children
Kingella kingae
Diagnostics used for Osteomyelitis
- Blood culture
- history and physical findings
- Aspiration for Gram stain
- Culture: confirms the diagnosis
- Aspiration of bone pus: best specimen
- elevated ESR and CRP: assess response to therapy or identify complications
treatment for osteomyelitis in neonates
- Antistaphylococcal Penicillin
:Nafcillin or Oxacillin (150-200 mkd q6) and
Cefotaxime (150-200 mkd q8)
MRSA: Vancomycin and aminoglycoside
treatment of osteomyelitis in older children
- Cefazolin (100-150mkd q6) or nafcillin (150-200mkd q6)
- Cefotaxime or Ceftriaxone if no H. Influenza vaccine
- have the potential to cause permanent disability
- frequency is increased in infants and toddlers
- Staphylococcus aureus Infection is most common
- Gonococcus in Sexually active adolescents
- 50% occur by 2 y/o, % of cases in 5 y/o
- majority of infections in otherwise healthy children are of hematogenous origin
- can follow penetrating injuries
Suppurative Arthritis/Septic Arthritis
diagnostics for suppurative arthritis
- Blood culture
- Gram stain and culture definitive diagnostic technique
- Elevated ESR and CRP
- Plain films: widening of the Joint capsule, soft tissue edema, and obliteration of normal fat lines
- Ultrasonography: highly sensitive in detection of joint effusion, particularly for the hip joint (aid in aspiration)
- CT and MRI; useful in confirming presence of joint fluid
treatment for suppurative arthritis
- Neonates: nafcillin or oxacillin and cefotaxime
- Children: cefazolin or nafcillin
- MRSA: Clindamycin and vancomycin
- Immunocompromised: vancomycin and ceftazidime or
- extended-spectrum penicillins and B-lactamase inhibitors
- with an aminoglycoside
- Dexamethasone for 4 days
- Daily aspiration of synovial fluid: Joints
- Surgical emergency: hip
achondroplasia
- prototype of chondrodysplasia
- at birth: short limbs, long narrow trunk, large head with midfacial hypoplasia and prominent forehead
- limb shortening: greatest in the proximal segments, and the fingers often display a trident configuration
- Most joints are hyperextensible, but extension is restricted at the elbow
- an autosomal dominant trait
- delayed motor milestones, normal intelligence,
exaggerated lumbar lordosis - Infants and children: progressively fall below normal standards for length and height, large heads
- large calvarial bones
- small cranial base & facial bones
- short vertebral pedicles, decrease interpedicular
distance, 1st to the 5 lumbar vertebra - fibula is disproportionately long compared with tibia
- Surgical correction for severe spinal canal stenosis
Achondroplasia
- most common genetic cause of osteoporosis
Osteogenesis Imperfecta (brittle bone disease)
- generalized disorder of connective tissue
• structural or quantitative defects in type I collagen
(primary component of the extracellular matrix of bone and skin) - autosomal dominant
TRIAD of Osteogenesis imperfecta
fragile bones
blue sclerae
early deafness
- autosomal dominantly inherited disorder
- abnormal biosynthesis of fibrillin-1 (major constituent of microfibrils provide scaffolding network of elastin and have an anchoring function in nonelastic tissue- aortic adventitae & eye’s suspensory ligament)
Marfan Syndrome
