Acute Orthopaedic Presentations

Question 1

What is osteomyelitis?

Answer 1

• Bacterial infection of bone usually in metaphyseal area
• Presents with fever, chills, severe pain, swelling & tenderness
• Can spread to joint & cause septic arthritis
• Can be extremely destructive quickly

Question 2

Where is osteomyelitis commonly found?

Answer 2

Distal femur & proximal tibia

Question 3

What is osteomyelitis caused by?

Answer 3

• Skin or sore throat

- Occasionally from open fracture

Question 4

What is the treatment for osteomyelitis?

Answer 4

• Aspiration, antibiotics & immobilisation
• Sometimes surgical decompression
• Septicaemia life threatening
• Physio role in mobility post acute management

Question 5

What is septic arthritis?

Answer 5

• Infection of a joint caused by bacterial organisms
• Fast destruction of articular cartilage & long term growth arrest (48hrs)
• Can destroy head of femur & pressure AVN
• Affects hip & knee

Question 6

What are the clinical signs of septic arthritis?

Answer 6

• Fever
• Irritability
• Refusal to move affected joint
• Warm, swollen joint held in flexion (but may walk)
• Elevated leukocyte count & ESR
• XR & US show distended joint capsule

Question 7

What is the treatment for septic arthritis?

Answer 7

• Aspiration, drainage & IV antibiotics

- Physio role in mobility post acute management

Question 8

What is transient synovitis (irritable hip)?

Answer 8

• Most common cause of hip pain <10 years old
• Gradual/acute onset limp
• Mild-mod hip/knee pain
• Mild fever, normal leukocyte count & ESR
• Often recent URTI
• Lasts about 7 days

Question 9

What is the treatment for transient synovitis?

Answer 9

• Treat symptoms (decrease activity, bed rest, crutches)

- Physio role in supporting mobility & decreased activity

Question 10

What is Legge Calve Perthes disease?

Answer 10

AVN of ossific nucleus of femoral head (medial circumflex artery)

Question 11

What is the clinical presentation of Perthes?

Answer 11

• 3-12 years (mostly boys 5-7)
• 20% bilateral
• Groin, hip or knee pain
• Muscle weakness, ROM limitations (abd, IR) & trendelenberg gait
• May follow transient synovitis

Question 12

What is the treatment for Perthes?

Answer 12

• ROM exercises
• Bracing
• Hydro
• Petrie casts (abd & IR)
• Surgery
• Self limiting & heals within 1-3 years (femoral head revascularises)

Question 13

What is slipped capital femoral epiphysis (SCFE)?

Answer 13

Growth plate of proximal femoral epiphysis becomes weak & displaced

Question 14

What are the 3 presentations of SCFE?

Answer 14

• Acute trauma: Severe pain, restricted hip abd & IR
• Acute on chronic: Aching hip/thigh/knee, then significant trauma causes epiphysis to slip further
• Chronic: Limp & pain weeks/months, reduced ROM in abd & IR

Question 15

What are the common clinical signs of SCFE?

Answer 15

• 75% obese
• Leg held in ER in supine & standing
• Reduced ROM in flexion, abd & IR

Question 16

What are the treatments for SCFE?

Answer 16

• Surgical fixation: Can lead to AVN chondrolysis & OA in later life
• Physio role in mobility post op, hydro