Ortho- peds Flashcards
Transient Synovitis- epidemiology
3-8 yr
B>G
Antalgic gait - hips abducted and externally rotated, pain with internal rotation
Transient Synovitis- S/S & PE
No fever
Not toxic
Hurt, not tender
Septic Arthritis- S/S & PE
Acute onset fever joint pain loss of function in joint Swelling limited ROM Malaise Irritable
Joint effusion
warm/tender
Septic Arthritis- diagnosis
U/S
Xray
Septic Arthritis - labs & imaging
CBC - left sift
APR - inc
BC
Septic Arthritis - treatment
IV abx
Surgery/drainage
REFER
Osteomyelitis- pathophysiology
Infection localized in bone
Infection in metaphysis -> cellulitis of BM -> exudate under pressure forced into cortex -> lifts periosteum
Osteomyelitis- cause
Direct inoculation
Hematogenous spread - more common
Osteomyelitis- epidemiology
Uncommon
<5
Osteomyelitis- S/S & PE
Tubular bones
Osteomyelitis- labs & imaging
Gram pos - Staph
Osteoid Osteoma- pathophysiology
Bone forming non-malignant lesion
Osteoid Osteoma- epidemiology
B>G
Osteoid Osteoma- S/S & PE
LE - proximal femur Prog pain - worse at night - affected by activity? Limp, swelling, muscular atrophy Leg length, bone deformities Local point tenderness Relief w/ NSAIDs
Osteoid Osteoma- diagnosis
Xray - small radiolucent nidus <1-1.5cm
Might need CT
Osteoblastoma- pathophysiology
Bone forming non-malignant lesion
Osteoblastoma - epidemiology
Rare
B>G
Osteoblastoma- S/S & PE
Posterior column spine
Chronic pain
- less response to NSAIDs
Expansive bony lesion
Osteoblastoma - diagnosis
CT, MRI - larger >2cm
Osteoblastoma - treatment
Curettage and bone grafting
Osteochondroma- pathophysiology
Cartilage forming non-malignant lesion
Cartilage-capped bony spur arising on external surface of bone
Osteochondroma - epidemiology
B>G
Osteochondroma - S/S & PE
Distal femur - most common
Knee, proximal humerus
Osteochondroma - diagnosis
Xray - osseus spur - cauliflower head
MRI - eval adjacent tissue swelling
Osteochondroma - treatment
Observe w/out treatment
Xray yearly
Osteosarcoma- pathophysiology
Malignant lesion
Osteosarcoma- epidemiology
Most common malignant bone lesion
13-16 yo
Osteosarcoma- S/S & PE
Metaphysis of long bones - femur
Localized pain for months
- after injury, waxes and wanes
Larger, tender soft tissue mass
Osteosarcoma- diagnosis
Xray - SUNBURST
Biopsy
Osteosarcoma- labs & imaging
Labs - nl
alk phos
LDH
Osteosarcoma- treatment
Chemo
Ewings Sarcoma- S/S & PE
Long bones - Femur, tib/fib, humerus
Local pain and swelling
- aggravated w/ exercise, worse at night
Ewings Sarcoma- diagnosis
Xray - moth eaten, Codman’s triangle, Onion peal
Salter-Harris Classification- pathophysiology
I-II - well w/ little complication
III-V - require percutaneous pinning or open reduction and internal fixation
- higher rate of growth disturbance
V - immediate growth plate closure -> shortening of extremity
Buckle Fractures- pathophysiology
Compression force
- FOOSH
Buckle Fractures- S/S & PE
Radius, Ulna
Buckle Fractures- treatment
Don’t need reduction
Heal w/ immobilization
Bowing Fractures- pathophysiology
Longitudinal force on shaft of long bone
- exceeds bone ability to recoil back to normal position
Bowing Fractures- S/S & PE
Ulna, radius
Bowing Fractures- treatment
<20deg or <4yo - self corrects
REFER -> reduction
Greenstick Fracture- pathophysiology
Bone bent w/ a fracture line that does not extend completely through width of bone
Greenstick Fracture- diagnosis
Xray -
- Tension side - fracture
- Plastic side - buckling
Greenstick Fracture- treatment
High risk for repeat
Immobilization
Refer
Supracondylar fracture- cause
Fall on an out-stretched arm w/ elbow extension
Supracondylar fracture- epidemiology
Most common elbow injury
Supracondylar fracture- S/S & PE
Concern for NV compromise!! Elbow pain Swelling Guarding NO ROM