Orthopedics

Question 1

What is a slipped capital femoral epiphysis?

Answer 1

A salter harris I type fracture where the physis of the femoral head slips
- External Rotational deformity

Question 2

Clinical features of a slipped capital femoral epiphysis?

Answer 2

• Acute: sudden severe pain with limp
• Chronic: limp with medical knee or anterior thigh pain
• Tenderness over joint capsule
• Resistricted internal rotation, ABduction, and flexion

Question 3

Treatment for slipped capital femoral epiphysis?

Answer 3

Mild-mod: stabalize physis with pins in current position

Severe: ORIF

Question 4

What are the major complications of slipped capital femoral epiphysis?

Answer 4

• Avascular necrosis
• Chondrolysis (v articular cartilage)
• Premature OA
• Decreased ROM

Question 5

What is Legg-Calve-Perthes Disease?

Answer 5

• A degenerative disease of the hip joint where growth/loss of bone mass leads to deformity of the ball of the fumur and surface of the hip socket.
• Characterized by Idiopathic avascular osteonecrosis of the capital femoral epiphysis

Question 6

What are the key features of Legg-Calve-Perthes Disease?

Answer 6

• AVN of proximal femoral epiphysis
• Abnormal growth of physis
• Remodeling of regenerated bone (eventually)

Question 7

How is Legg-Calve-Perthes disease managed?

Answer 7

• Non-weight bearing, peds ortho referral
• ROM exercise
• Brace in flexion and ABduction for 2-3 years
• Pelvic or femoral osteotomy (surgical removal of bone)
• 50% do well with conservative tx

Question 8

Clinical features of Legg-Calve-Perthes disease?

Answer 8

• Child with hip pain and limp
• Tender over anterior thigh
• Flexion contracture (decreased internal rotation and ABduction of hip)

Question 9

What will you see on X-ray in pt with Legg-Calve-Perthes disease?

Answer 9

• Collapse of femoral head
• Subchondral fracture
• Metaphyseal cyst

Question 10

What is compartment syndrome?

Answer 10

• Increased interstitial pressure in an anatomical compartment where muscle and tissue are bounded by faschia and bone with little room for expansion.
• Interstitial pressure exceeds capillary perfusion pressure leading to muscle and eventually nerve necrosis

Question 11

What is the pathogenesis of compartment syndrome?

Answer 11

• Increased pressure from blood and intracompartment swelling
• Decreased venous and lymphatic drainage
• Intracompartmental pressure becomes greater than perfusion pressure
• Muscle and nerve anoxia > necrosis
• Leaky basement membranes cause transudarion into tissue surrounding compartment, increasing pressure

Question 12

What are the 5 P’s of compartment syndrome?

Answer 12

• Pain (out of proportion to injury)
  
  • Increased pain with passive strech is most specific sign
• Pallor
• Paresthesia
• Paralysis (late)
• Pulselessness (late)

Question 13

What are the clinical features of compartment syndrome?

Answer 13

• Pain with passive stretch (most specific)
• Swollen, tense compartment
• Suspicious history
• 5 P’s

Question 14

What is the treatment for compartment syndrome?

Answer 14

• Non-operative: Remove constrictive dressing (casts, splints, etc) and elevate the limb to heart level
• Operative: Urgent fasciotomy
• 48-72 days post op you can close the wounds and may need to debride necrotic tissue

Question 15

What are the compartment pressure readings associated with compartment syndrome?

Answer 15

• Elevated compartment pressure: 30mmHg (normal is 0mmHg)

- Ischemia occurs when tissue pressures approach diastolic pressure (get concerned when it’s within 30mmHg of diastolic)