Orthopaedics Flashcards
What is Perthes?
Disruption of blood flow to femoral head causing avascular necrosis
What are the stages of Perthes?
Avascular necrosis
Fragmentation (revascularisation)
Reossification
Residual deformity
Who typically gets Perthes?
4-8yo
Males >females
What are the risk factors for Perthes?
Socioeconomic deprivation
Hypercoagulable states
What is the presentation of Perthes?
Limp Limited ROM Short stature Muscle wasting Pain- grin, thigh, knee Systemically well
What is the investigation of Perthes?
Bilat hip XR
What is the management of Perths in <6s?
- Mobilise and monitor
2. operative or non op containment
What is the management of Perthes in >6s?
Surgical containment or salvage procedure
What are the complications f Perthes?
Osteoarthritis
Limb length inequality
What is SUFE?
Slipped upper femoral epiphysis
Posteriomedial displacement of proximal femoral epiphysis in relation to neck
Who is SUFE seen in?
9-16yo, typically >11
Associated with growth spurt and obesity
What is the presentation of SUFE?
Pain- groin, thigh, knee Limited ROM Limp Deformity- external rotation, esp on flexion Possible history of trauma
How is SUFE diagnosed?
Frog lateral XR- slipped ice cream cone appearance
What is the management of SUFE?
Operative- pin in situ
What are the complications of SUFE?
Avascular necrosis
Chrondrolysis
Deformity
Early osteoarthritis
What are the causative organisms of septic arthritis?
Usually staph aureus
Consider N. gonorrhoea in sexually active
What are the routes of infection of septic arthritis?
HAematogenous spread
Dissemination from osteomyelitis
Spread from adjacent soft tissue infection
What is the presentation of septic arthritis?
Limping with no weight bearing Pseudoparalysis, refusal to move joint Swollen red joint Pain Temperature Unwell
What investigations are done for septic arthritis?
Bloods- high WCC, CRP and ESR, cultures and CK
US
What is the management of septic arthritis?
IV antibiotics
Needle aspiration and arthroscopic lavage
What is the most common causative organism of osteomyelitis?
Staph aureus
What is the presentation of osteomyelitis?
Pain
ROM better and weight bear more, and more well than septic arthritis
Fever, generally not right
What bones are most often affected by osteomyelitis?
Long bones of arms and legs
What investigations are done for osteomyelitis?
Bloods- WCC often normal, CK, CRP, ESR, cultures
MRI
XR
What is the management of osteomyelitis?
Antibiotics
What are the indications for surgery in osteomyelitis?
Collection in periosteum
Infection spread into joint
Atypical bacteria
Debridement of dead tissue
What is transient synovitis?
Infection of hip joint secondary to virus
Most common cause of hip pain in children
Who is transient synovitis seen in?
2-10yo
What is the presentation of transient synovitis?
Acute hip pain associated with viral infection
Hobbling limp, will weight bear slightly
No temperature
Usually fairly well
How is transient synovitis diagnosed?
CLinical
What is the management of transient synovitis?
Self limiting
Rest and analgesia
What is rickets?
Defective bone mineralisation due to severe vit D/Ca deficiency
What are the risk factors for rickets?
Darker skin
Low exposure to sunlight
Colder climates
What is the presentation of rickets?
Stunted growth and failure to thrive Bandy legs Large abdoman Large forehead Wide joints
What investigations are done for rickets?
XR- radiolucency
Serum 25 hydroxuvitamin D
Serum Ca and phosphate
What is the management of rickets?
Vit D and Ca supplementation
