Orthopaedics Flashcards
Classification of fractures
Salter-Harris classification - detrmine likely hod to affect growht
SALTR
1- Straight
2 - Above
3 - beLow
4 - Through
5 - cRush
Management of fractures
Closed or open reduction
External casts
K wirse
Intramedullary wires
[Intramedullary nails
Screws
Plates
Pain management in children
Paracetamol
Ibuprofen
Morphine
Not codeine
Not tramadol
Causes of hip pain in 0-4 years
Septic arthritis
Developmental dysplasia
Transient sinovitis
Causes of hip pain in 5-10 years
Septic arthritis
Transient sinovitis
Perthes disease
Causes of hip pain in 10-16 years
Septic arthritits
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis
Red flags of hip pain
Child under 3
Fever
Waking at night with pain
Weight loss
Anorexia
Night sweats
Fatigue
Persistent pain
Stiffness in morning
Swollen or red joint
Investigations of hip pain
Bloods
Xray
US
Joint aspiration
MRI
Define septic arthritis
Infection inside a joint -
Presentation of septic arthritis
Hot
Red
Swollen
Painful joint
Refusing to weight bear
Stiffness
Reduced rang of motion
Systemic symptoms - fever, lethargy, sepsis
Commm causitive organism in septic arthritis
Staphylococcus aureus
Commm causitive organism in septic arthritis
Staphylococcus aureus
Neisseria gonorrhoea
Group A strep
Haemophilus influenza
E. Coli
Investigations in septic arthritis
Joint aspiration
Management of septic arthritis
IV antibiotics
Surgical drainage and wash out
Supportive management
Define transient synovitis
Temporary irritation and inflammation in the synovial membrane of the joint.
Most common cause of hip pain in 3-10 years
Often preceded by URTI
Presentation of transient synovitis
URTI
Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature
Otherwise well!
Management of transient synovitis
Symptomatic management
Exclusion and close monitoring for septic arthritis
Define perthes disease
Disruption of blood flow to the femoral head causing a vascular necrosis.
Presentation of Perthes disease
Pain in the groin or hip
Limp
Restricted hip movement
Referred pain to knee
Investigations in Perthes disease
Blood tests
Technetium bone scar
MRI
Management of Perthes disease
Conservative
Bed rest
Traction
Crutches
Analgesia
Physio
Monitoring and surgery
Define slipped upper femoral epiphysis
Slipped capital femoral epiphysis - where the head of the femur is displaced along the growth plate.
Presentation of SUFE
Adolescent
Obese
Male
During growth spurt
Caused by minor trauma
Hip groin thigh or knee pain
Restricted range of movement
Painful limp
What movement is normal restricted in SUFE
Restriction of internal rotation - like to keep externally rotated
Investigation of SUFE
Bloods
Technetium bone scan
CT
MRI
Management of SUFE
Surgery
Define osteomyelitits
An infection in the bone and bone marrow - typically in the metaphysis of long bones.
Risk factors for osteomyelitis
Open bone fractures
Orthopaedic surgery
Immunocompromised
Sickle cell anaemia
HIV
TB
Presentation of osteomyelitis
Refusing to use limb or weight bear
Pain
Swelling
Tenderness
Acutely unwell child
High fever
Investigations in osteomyelitis
Xrays
MRI
Bloods
Culture
Marrow aspiration
Define osteosarcoma
Bone cancer usually presenting in 10-20 years in the femur, tibia or humerus
Presentation of osteosarcoma
Persistent bone pain
Worse at night - disturbing sleeo
Swelling
Palpable mass
Restricted joint movement
Investigation of osteosarcoma
Xray!
Bloods - ALP
CT MRI
PET
Bone
Biopsy
Management of osteosarcoma
Surgical resection
Limb amputation
Adjuvant chemo
MDT support
Define Talipes
Club foot - fixed abnormal ankle position that presents at birth
Corrected with surgery
Define developmental dysplasia of the hip
Condition where there is a structural abnormality in the hips caused by abnormal development of fetal bones during pregnancy
Leads to instability and dislocation
Risk factors for developmental dysplasia of the hip
First degree family history
Breech presentation
Multiple pregancy
Clinical signs of developmental dysplasia of the hip
Different leg lengths
Restricted hip abduction on one side
Signification bilateral restriction in abduction
Ortolani and barlow test
Define Ortolani test
Baby on back - abduct hips
Applying pressure to identify if likely to dislocate anteriorly
Define Barlow test
Gentle downward pressure on hip adduction to identify if dislocates posteriorly
Investigations in developmental dysplasia of the hip
US!
Xray if older
Management of developmental dysplasia of the hip
Pavlik harness - hold femoral head in correct position
Surgery
Define riskets
A condition affecting children where there is a defection mineralisation of bones leading to soft and deformed structures.
Causes of Riskets
Vit D or calcium deficiency
Presentation of rickets
Bowing legs
Knock knees
Rachitic rosary - ribs expand at the costochondral junction - lumps along chest
Craniotabes - soft skull - delayed closure of sutures and frontal bossing
Delayed teeth
Risk factors for vit D deficiency
Lethargy
Bone pain
Swollen wrists
Bone deformity
Dental problems
Muscle weakness
Pathological fractures
Investigations in rickets
Vit D
Xray
Serum calcium phosphate
ALP
Parathyroid hormone
Bloods
Autoantibodies
Management of rickets
Prevention!
Breastfeed!
Formula with fortified vit D
Vit d replacement
Calcium supplementation
Correct deformities
Define achondroplasia
Most common cause of disproportionate short stature, mostly caused by autosomal dominant patter of homozygous gene mutations
Presentation of achondroplasia
Limbs affects more than spine.
Short digits
Bow legs
Disproportionate skull
Foramen magnum stenosis
COnditions associated with achondroplasia
Recurrent otitis media - cranial abnormalities
Kyphosis
Spinal stenosis
Obstructive sleep apnoea
Obesity
Foramen magnum stenosis - cord copression, hydrocephalus
Management of achondroplasia
MDT supportive management
Leg lengthening
Define Osgood-Schlatters disease
Caused by inflammation at the tibial tuberosity where the patella ligament inserts - anterior knee pain in adolescents
Presentation of Osgood-Schlatter
Visible or palpable hard and tender lump
Pain at anterior aspect of knee
Pain exacerbated by physical movement
Management of Osgood-Schlatters
Reduce physical activity
ICE
NSAIDs
Physio
Define osteogenesis imperfecta
Genetic condition that results in brittle bones that are prone to fractures - affects formation of collagen
Presentation of osteogenesis imperfecta
Blue sclera!
Unusual and recurrent fractures
Hypermobility
Triangular face
Short stature
Deafness
Dental problems
Bone deformities - bowed legs
Joint and bone pain
Management of osteogenesis imperfecta
Genetic counselling
Bisphosphonates
Vit D supplementation
MDT support
