Musculoskeletal Disorders Flashcards
Developmental dysplasia of the hip
Seek specialist ortho
Infant may need splint or Pavlik harness to keep the hip flexed and abducted
Monitored by repeat x-ray or USS
Surgery indicated if conservative measures fail
All children born breech or w/ a strong family Hx of DDH should have an USS at 6 wks
From 6m onwards hip xray is better than USS
Summary:
- most will self resolve spontaneoussly by 3-6 weeks
- Pavlik harness in children that are younger than 4-5 mo
- older children may need surgery
Talipes equinovarus
plaster casting (ponseti) surgery if severe
Acute osteomyelitis
high dose IV emperical ABx 2-4wks
Once recovery is demonstrated clinical recovery and acute phase reactants have returned to normal pts can be switched to PO
NB take blood cultures before starting ABx, adjust once sensitivities known
?surgical debridement
Chronic osteomyelitis
clinical assessment, staging (cierny-malder) and optimisation of comorb.
Debridement
IV abx
functional rehab
Osgood-Schlatter Dx
Pain: P/I, ice packs, knee pads
Will resolve may persist until end of growth spurt
Advise stopping all sports, then gradual reintroduction of non-impact first
Introduce low-impact quad exercises
Stretching can help Sx
Chondromalacia patellae
PT for quad strengthening
Osteochodritis dissecans
P/I
Rest and quad exercises
?surgery (remove intra-articular loose bodies)
subluxation and dislocation of patella
reduction and immobilsation
rehab (ROM exercises and isometric strengthening)
Transient synovitis
FBC, CRP, x-ray
If any doubt of septic arth. get aspirate and blood cultures
rest, pain relief
Perthes disease
Ix: x-ray (may need MRI in early stage)
Acute pain - simple analgesia
<5y: mobilisation and monitoring (healing potential good), non-surgical containment (splints)
5-7y: mobilisation and monitoring, surgical containment
7-12y: surgical containment, salvage remodelling of acetabulum)
12+: salvage, replacement arthroplasty
Slipped capital femoral epiphysis
internal fixation across growth plate
Reactive arthritis
NO Mx needed
simple analgesia
consider steroids
Septic arthritis
Prolonged Abx (IV 2w, 4w PO)
- Sus G+: vancomycin and joint aspiration (2L clind+cephalosporin)
- Sus G-: 3rd gen ceph. + aspiration, (2L: ciprofloxacin)
Affected joints should be aspirated to dryness PRN
?washing/surgical draining
Juvenile Idiopathic Arthritis
Specialist pead rhuem MDT
PT/OT
Inactivity leads to deconditioning, disability and decreased bone mass
NSAIDs control pain and stiffness
Corticosteroids useful adjunct
DMARDs (PO/SC MTX) used when failure to respond (2L sulfalazine)
Consider anti-TNF, IL receptor antagonists
PROGNOSIS:
most can expect good control and good QOL
w/poorer control significant morbidity from damage and visual impairment from uveitis
Vit D deficiency in children
Usually: Calcium + ergocalciferol/colecalciferol
If defect in 1-alpha hydroxylase: calcitriol or alfacalcidol
Phosphate salts used in hypophosphataemic rickets
