orthopaedics Flashcards
perthes disease what is it
avascualr necrosis of femoral head for know known reason
perthes disease presentation
limp
pain in hip
limited abduction and internal rotation
perthes disease investigations and findings
x ray - joint space widening due to lack f blood supply
perthes disease management
younger <6 the better prognosis - can remodel
bed rest and NSAIDS <1/2 femoral head effected (herring A/B)
surgery if older >1/2 femoral head effected (herring BC/C)
slipped upper femoral epiphysis what is it
10-16yr obese males
displacement through growth plate with epiphysis slipping down and back
slipped upper femoral epiphysis presentation
limp
flexion, abduction, medial rotation limited
risk early OA if missed
symptoms usually present for weeks to several months before diagnosis
slipped upper femoral epiphysis management
surgical
septic arthritis cause
s.aureus (most common)
h.influenza (if unvaccinated)
assume in all limping children
septic arthritis presentation
spetic signs - low BP, high HR/RR/lactate
warm tender joint
reduced ROM
usually one joint infected
septic arthritis investigations
joint aspiration
mc+s
kocher criteria for septic arthritis
WCC >12,000
Inability to bear weight
Fever >38.5
ESR >40
all 4 99% septic arthritis
hip septic arthritis causes
Group B streptococcus – neonates
Staph aureus – common in children > 2 years of age
Neisseria gonorhoeae – most common in adolescents
transient synovitis of the hip cause
most common casue of hip pain in children
diagnosis is by exclusion of others
transient synovitis of the hip aetiology
viral illness preceded by recent viral URTI
transient synovitis of the hip management
NSAIDS
development dysplasia of the hip risk factors
female
breech
family Hx
first born
development dysplasia of the hip investigations
barlow and ortolani manoeuves
observe asymmetry, leg length, skin folds
development dysplasia of the hip diagnosis
US
important to diagnose early as risk OA
development dysplasia of the hip management
<6 months - long term splinting, pavlik harness
6-18 months - immobalise, examine under anaesthetic
>18 months - surgical correction
osteogenesis imperfecta what is it
inherited disorder of type 1 collagen
joint laxity, fragile low density bones
osteogenesis imperfecta presentation Sillence classification (4 types)
type 1 - mild, most common. many fractures, blue sclera, hearing loss
type 2 - lethal perinatal. many fractures, blue sclera, dwarfism
type 3 - severe. many fractures, spine limb deformity, transparent teeth
type 4 - moderate
osteogenesis imperfecta diagnosis
x ray - low bone density, bowing of longer bones
osteogenesis imperfecta management
bisphosphonates - alendronate
always think of non accidental injury
rickets what is it
low bone mineral content
rickets presentation (presentation of symptomatic vitamin D deficiency)
growth retardation, hypotonia, bow legged, hypocalcaemic convultions, fractures
ricketts causes
vit d deficiency - malabsorption, poor diet
drug induced - anticonvulsants
renal osteodystrophy
ricketts investigations
low PO43- raised ALP raised PTH low active (25-hydroxy) vitamin D
ricketts management
vit d and calcium
osteomyelitis common organisms
staph aureus
pseudomonas
e.coli
h.influenza
osteomyelitis presentation
gradual onset
unwillingness to move
tender, warm, erythema
osteomyelitis management
vancomycin and cefotaxime until organism known
osteomyelitis investigations
raised esr,crp,wcc
mc+s
bone biopsy
juvenile idiopathic arthritis diagnosis
normocytic anaemia
raised platelets WBC ESR/CRP
ANA RF HLA B27
juvenile idiopathic arthritis managment
paracetamol and NSAIDS
methotrexate (dmard)
tocilizumab - il6 receptor blocker decrease inflammatory cytokine production
juvenile SLE features SOAP BRAIN MD
mainly adolescent females. relapsing and remitting
serositis
oral ulcers
arthritis
photosensitivity
bloods - anaemia, thrombocytopenia, leucopenia, low c3/c4 renal - proteinuria ANA Immune - double stranded DNA neurological - seizures, psychosis
malar rash
discoid rash
juvenile SLE management
hydroxychloroquine and NSAIDS
juvenile idiopathic arthritis presentation
fever spikes with salmon pink rash and joint Pain Swelling - persistent Joint stiffness (morning) Loss of range of movement Joint deformity Warmth Colour change
juvenile idiopathic arthritis - oligoarticular
less than 4 joints
knee and ankle are common
juvenile idiopathic arthritis - polyarticular
more than 4 joints
septic arthritis management
staph areus - IV Cefuroxime
