Musculoskeletal emergencies

Question 1

How might you differentiate a septic arthritis from a transient synovitis of the hip in a child?

Answer 1

Septic arthritis has a tender hot swollen joint
Spetic arthritis has a high grade fever
Transient synovitis has a low grade fever with normal bloods - it is a diagnosis of exclusion

Question 2

What is the management of suspected infected total hip replacement?

Answer 2

Broad spectrum antibiotics

Blood cultures, gram stain, ESR/CRP, FBC and Aspirate

Question 3

What are the kanavel signs associated with infective tenosynovitis of the hand?

Answer 3

Finger held in slight flexion
Uniform swelling
Pain on tendon palpation
Pain on passive extension

Question 4

What are the typical causative organisms of infected hip replacement?

Answer 4

S. aureis

E coli

Question 5

What are the classical features of compatment syndrome?

Answer 5

Pale
Pulseless
Perishingly cold
Paresthesia
Pain

Question 6

What are some of the ways that DVT risk is reduced post surgery?

Answer 6

TED stockings
Pneumatic compression
Electrical stimulation

Question 7

What is the most common type of bone cancer?

Answer 7

Osteochondroma - benign

Question 8

What clinical features do most patients present with when they have bone cancer?

Answer 8

Deep boring bone pain

Question 9

What agegroup of patients tyically get osteosarcoma?

Answer 9

Typically young (10-20 years)

Question 10

What are the classic radiographic features of bone tumours?

Answer 10

Usually have a sharp boder - narrow zone of transition
Matrix has calcifications
Periosteal reaction - solid or interuppted
Bone destruction - moth-eaten, geographic