Orthopaedic Presentations Flashcards
Describe the pathophysiology and aetiology of osteomyelitis
Infection of the bone
- acute haematogenous spread
- sec to contiguous local infection
- direct inoculation from trauma/surgery
Common site = distal femur, proximal tibia
Common MO = staph a, pseudomonas, E.coli, strep
Other = salmonella, mycobacteria, fungi
Outline the S+S of osteomyelitis
Gradual onset pain
Unwillingness to move
Local = tenderness, warmth, erythema, slight effusion
How should suspected osteomyelitis be Ix?
Raised ESR, CRP, WCC
Blood culture
Bone biopsy + culture
X-ray = not apparent for 10-14d, then hazy, loss of density, subperiosteal reaction, sequestrum, involucrum
MRI
How should osteomyelitis be Mx?
Surgery to drain abscesses and remove sequestra
6w Abx - vancomycin + cefotaxime until MO and sensitivities known
What are the possible complications of osteomyelitis?
Amyloid
SSC devel in sinus tract
Outline the pathophysiology of rickets
Path = decreased availability of phosphorus and calcium to mineralize the skeletal matrix, leading to growth plate disorganization and accumulation of undermineralized osteoid. This results in growth plate expansion, bone weakening, and skeletal deformities
List the causes of rickets
Vit D def
- malnutrition
- no sunlight
- Celiac disease
- Inflammatory bowel disease
- Cystic fibrosis
- Kidney problems
Ca def
- malnutrition
- vit D def
Hypophosphatemic rickets - rare, genetic
How does rickets present?
- Craniotabes (ping-pong ball sensation of head)
- Delayed growth
- Delayed motor skills
- Pain in the spine, pelvis and legs
- Muscle weakness
- Bowed legs or knock knees
- Thickened wrists and ankles
- Breastbone projection
How should suspected rickets be Ix?
Head-to-toe bone exam
X-ray wrist = cupping and fraying of metaphyses and widened epiphyseal plate
Bloods = low/normal Ca, low phosphorus, alk phos high, vit D low, PTH high
How should rickets me Mx?
Vit D and calcium supplements
Hypophosphatemic rickets = phosphorus supplements
Brace = position body appropriately as the bones grow
Severe deformity = surgery
What are the possible complications of rickets?
Failure to grow
An abnormally curved spine
Bone deformities
Dental defects
Seizures
Outline paediatric scoliosis
Lateral curvature in the frontal plane, measuring 10 degrees or more
Causes = idiopathic, CP, muscular dystrophy, inherited, diff leg lengths, injury, infection, tumours
Mx = observation, bracing, surgery
Outline paediatric torticollis
Tight, short neck muscle resulting in abnormal positioning of the neck
Affects the right side more often than the left side
Most common cause in infants is SCM tumour
Mx = gentle stretching, infant stimulation, surgery
