Orthopaedics Flashcards
What is the most common cause of hip pain in children 3-10 years?
Transient toxic synovitis (often follows viral respiratory infection)
What is the appropriate work-up for toxic synovitis?
CBC, CRP/ESR, radiographs, joint aspiration (diagnosis of exclusion and MUST rule out septic arthritis with aspiration)
What is Legg-Calve-Perthes Disease?
Idiopathic osteonecrosis of the femoral head
What is a significant predictor of poor outcome with LCPD?
Older age at onset
What is the initial treatment for LCPD?
Rest and PT
What is patellofemoral pain syndrome?
Overuse syndrome in runners due to maltracking of the patellofemoral joint. Pain is anterior in the patellar region and exacerbated by running, squatting, stair climbing and prolonged sitting with the knee bent.
What is the treatment for PFPS?
PT with quad and hip strengthening
What is Osgood-Schlatter disease?
Overuse syndrome in jumping sports. Pain is over tibial tubercle
What is Plica syndrome?
Irritated synovial remnants (plicae) that did not resorb properly during development due to repeated flexion of the knee. Symptoms are pain and popping/snapping with knee flexion.
What is internal tibial torsion?
Excessive in-toeing with flexible, normal foot and patellae in neutral position.
How is internal tibial torsion diagnosed?
Place the child on his knees and assess for inward-pointing toes (rather than normal 30d of external rotation)
How is internal tibial torsion treated?
Watchful waiting until resolution by age 6 (unless always falling, then may need surgery)
What is SCFE?
Displacement of the femoral epiphysis in obese adolescents.
How is SCFE diagnosed?
AP and frog-leg lateral radiographs of the hip
How is SCFE treated?
Surgical fixation
At what Cobb angle should bracing be considered?
25-45d (only effective if child is still growing and < 1 year past menarche if female)
What is a nursemaid’s elbow?
Subluxation of the annular ligament over the radial head
How do you reduce a nursemaid’s elbow?
Supinate the forearm and flex the elbow while applying pressure over the radial head
What is a toddler’s fracture?
Spiral fracture over the tibia from insignificant rotational trauma (running and falling with a twisting motion)
How do you treat a toddler’s fracture?
Refer to orthopaedics for casting
What is the next step for a child with non-accidental trauma?
Skeletal survey
What types of fractures are highly specific for non-accidental trauma?
Metaphyseal corner fractures (due to high-energy tension/shearing forces)
Posterior rib fractures
What is meralgia paresthetica?
Burning pain in the anterior-lateral thigh caused by compression of the lateral femoral cutaneous nerve
What is the treatment for metatarsus adductus?
Watchful waiting unless the deformity is rigid in a child > 3 months or residual in a child > 6 months (serial casting/surgery)
What is the most common pathogen involved in osteomyelitis?
Staph aureus
How is the pathogen involved in osteomyelitis most typically identified?
Blood culture in 40-50% of cases (otherwise need aspiration at site of bony destruction with pathology)
What is the only sufficient test to definitely rule out septic arthritis?
Arthrocentesis
When should you start IV antibiotics for suspected septic arthritis?
Any time there is > 90% PMNs (WBC cut-offs vary), even if there are other fluid findings suggestive of alternative diagnosis
Where is the pes anserine bursa located?
Medial, proximal aspect of the tibia
What is a treatment option for pes anserine bursitis?
Corticosteroid injection
What is the most common organism causing septic arthritis in teenagers?
Gonococcus
What is considered a positive straight leg test?
When radicular symptoms occur (pain and paresthesias) below the level of the knee (not thigh) between 25-75 degrees of hip flexion while lying or with knee extension while seated and with passive ankle dorsiflexion. “Crossover” pain with radicular symptoms in the leg not lifted is very specific for disk disease but not very sensitive.
What exam sign should raise suspicion of spondylolisthesis?
Any adolescent athlete who has back pain worse with hyperextension.
At what time is surgical consultation recommended for spondylolisthesis?
Teen/young adult with > 50% slip or older adult with 100% slip
How does discitis usually present?
Children in infancy to age three, often without fever or elevated WBC and with sterile blood cultures, but with elevated ESR. Child has low back pain and limp. Treat with anti-staph antibiotic.
