Orthopaedics

Question 1

What is Perthes?

Answer 1

Disruption of blood flow to femoral head causing avascular necrosis

Question 2

What are the stages of Perthes?

Answer 2

Avascular necrosis
Fragmentation (revascularisation)
Reossification
Residual deformity

Question 3

Who typically gets Perthes?

Answer 3

4-8yo

Males >females

Question 4

What are the risk factors for Perthes?

Answer 4

Socioeconomic deprivation

Hypercoagulable states

Question 5

What is the presentation of Perthes?

Answer 5

Limp
Limited ROM
Short stature
Muscle wasting
Pain- grin, thigh, knee
Systemically well

Question 6

What is the investigation of Perthes?

Answer 6

Bilat hip XR

Question 7

What is the management of Perths in <6s?

Answer 7

1. Mobilise and monitor

2. operative or non op containment

Question 8

What is the management of Perthes in >6s?

Answer 8

Surgical containment or salvage procedure

Question 9

What are the complications f Perthes?

Answer 9

Osteoarthritis

Limb length inequality

Question 10

What is SUFE?

Answer 10

Slipped upper femoral epiphysis

Posteriomedial displacement of proximal femoral epiphysis in relation to neck

Question 11

Who is SUFE seen in?

Answer 11

9-16yo, typically >11

Associated with growth spurt and obesity

Question 12

What is the presentation of SUFE?

Answer 12

Pain- groin, thigh, knee
Limited ROM
Limp
Deformity- external rotation, esp on flexion
Possible history of trauma

Question 13

How is SUFE diagnosed?

Answer 13

Frog lateral XR- slipped ice cream cone appearance

Question 14

What is the management of SUFE?

Answer 14

Operative- pin in situ

Question 15

What are the complications of SUFE?

Answer 15

Avascular necrosis
Chrondrolysis
Deformity
Early osteoarthritis

Question 16

What are the causative organisms of septic arthritis?

Answer 16

Usually staph aureus

Consider N. gonorrhoea in sexually active

Question 17

What are the routes of infection of septic arthritis?

Answer 17

HAematogenous spread
Dissemination from osteomyelitis
Spread from adjacent soft tissue infection

Question 18

What is the presentation of septic arthritis?

Answer 18

Limping with no weight bearing
Pseudoparalysis, refusal to move joint
Swollen red joint
Pain
Temperature
Unwell

Question 19

What investigations are done for septic arthritis?

Answer 19

Bloods- high WCC, CRP and ESR, cultures and CK

US

Question 20

What is the management of septic arthritis?

Answer 20

IV antibiotics

Needle aspiration and arthroscopic lavage

Question 21

What is the most common causative organism of osteomyelitis?

Answer 21

Staph aureus

Question 22

What is the presentation of osteomyelitis?

Answer 22

Pain
ROM better and weight bear more, and more well than septic arthritis
Fever, generally not right

Question 23

What bones are most often affected by osteomyelitis?

Answer 23

Long bones of arms and legs

Question 24

What investigations are done for osteomyelitis?

Answer 24

Bloods- WCC often normal, CK, CRP, ESR, cultures
MRI
XR

Question 25

What is the management of osteomyelitis?

Answer 25

Antibiotics

Question 26

What are the indications for surgery in osteomyelitis?

Answer 26

Collection in periosteum Infection spread into joint Atypical bacteria Debridement of dead tissue

Question 27

What is transient synovitis?

Answer 27

Infection of hip joint secondary to virus | Most common cause of hip pain in children

Question 28

Who is transient synovitis seen in?

Answer 28

2-10yo

Question 29

What is the presentation of transient synovitis?

Answer 29

Acute hip pain associated with viral infection Hobbling limp, will weight bear slightly No temperature Usually fairly well

Question 30

How is transient synovitis diagnosed?

Answer 30

CLinical

Question 31

What is the management of transient synovitis?

Answer 31

Self limiting | Rest and analgesia

Question 32

What is rickets?

Answer 32

Defective bone mineralisation due to severe vit D/Ca deficiency

Question 33

What are the risk factors for rickets?

Answer 33

Darker skin Low exposure to sunlight Colder climates

Question 34

What is the presentation of rickets?

Answer 34

``` Stunted growth and failure to thrive Bandy legs Large abdoman Large forehead Wide joints ```

Question 35

What investigations are done for rickets?

Answer 35

XR- radiolucency Serum 25 hydroxuvitamin D Serum Ca and phosphate

Question 36

What is the management of rickets?

Answer 36

Vit D and Ca supplementation