Orthopaedic Presentations

Question 1

Describe the pathophysiology and aetiology of osteomyelitis

Answer 1

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

Question 2

Outline the S+S of osteomyelitis

Answer 2

Gradual onset pain

Unwillingness to move

Local = tenderness, warmth, erythema, slight effusion

Question 3

How should suspected osteomyelitis be Ix?

Answer 3

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

Question 4

How should osteomyelitis be Mx?

Answer 4

Surgery to drain abscesses and remove sequestra

6w Abx - vancomycin + cefotaxime until MO and sensitivities known

Question 5

What are the possible complications of osteomyelitis?

Answer 5

Amyloid

SSC devel in sinus tract

Question 6

Outline the pathophysiology of rickets

Answer 6

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

Question 7

List the causes of rickets

Answer 7

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

Question 8

How does rickets present?

Answer 8

• 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

Question 9

How should suspected rickets be Ix?

Answer 9

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

Question 10

How should rickets me Mx?

Answer 10

Vit D and calcium supplements

Hypophosphatemic rickets = phosphorus supplements

Brace = position body appropriately as the bones grow

Severe deformity = surgery

Question 11

What are the possible complications of rickets?

Answer 11

Failure to grow

An abnormally curved spine

Bone deformities

Dental defects

Seizures

Question 12

Outline paediatric scoliosis

Answer 12

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

Question 13

Outline paediatric torticollis

Answer 13

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