Orthopedics Flashcards
What is a Nursemaid’s Elbow
Dislocation or subluxation of radial head
What causes a Nursemaid’s Elbow
Sudden pull on an extended and pronated forearm, swinging a kid
Tx for Nursemaid’s Elbow
Reduction by pulling down on proximal radial head and supinating wrist
What is Slipped Capital Femoral Epiphysis
Fracture through the growth plate that results in slippage of overlying end of femur (epiphysis)
Who is more likely to get SCFE
Obese, Black/Latino Boys 14-16yrs old
Sx of SCFE
Hip pain or limping
Referred pain to thigh or knee
Walks with hip abducted and externally rotated
Limited internal rotation
Dx of SCFE
Hip Xray in frog leg view
Shows widening of epiphyseal plate
Displacement of femoral head
Tx of SCFE
Emergency
No weight bearing
Can lead to avascular necrosis
Spica hip cast for 6-8wks
What is Legg-Calve-Perthes Disease
Avascular necrosis of femoral head
Who is more likely to get Legg-Calve-Perthes
Bosy 4-8 years old
Sx of Legg-Calve-Perthes Disease
Walks with a limp
Leg length discrepancy
Limited hip ROM
Gradual onset of pain
Dx of Legg-Calve-Perthes Disease
Hip Xray first, but Hip MRI is preferred
Tx of Legg-Calve-Perthes Disease
Orthopedic referral
What is Osgood Shlatter Disease
Osteochondritis of patellar tendon at tibial tuberosity from overuse or small avulsion
Sx of Osgood Shlatter Disease
Activity related knee pain/swelling
Lump below the knee
Dx of Osgood Schlatter Disease
Xray shows prominence or ossification at tibial tuberosity
Tx of Osgood Schlatter Disease
RICE, NSAIDS, quads stretching
Surgery only if growth plate is closed
What is scoliosis
When the spine has lateral curvature greater than 10 degrees with vertebral rotation
When should screening for scoliosis start
6 yrs old with Adam’s forward bending
Measure Cobb Angle via Xray
Tx for Scoliosis
Bracing if 20-40 degrees
Observation if 40 degrees
What is Congenital Hip Dysplasia
When the femoral head is not properly aligned with the acetabulum
How can you screen for congenital hip dysplasia
Barlow Maneuver: Dislocation with posterior pressure on adducted hips
Ortolani Maneuver: Dislocation with anterior pressure on abducted hips
What is the risk with Congenital Hip Dysplasia
Can lead to abnormal growth and permanent instability
What type of neoplasm is Osteosarcoma
Most common malignant
What age does Osteosarcoma peak
2 peaks: before 20yrs, after 50yrs
Sx of Osteosarcoma
Pain, joint swelling, palpable soft tissue mass
Dx of Osteosarcoma
Xray - Hair on end
Tx of Osteosarcoma
Resection or amputation
Chemo as adjuvant
What type of neoplasm is Ewing’s Sarcoma
Malignant
Giant Cell Tumor
Sx of Ewing’s Sarcoma
Bone pain, palpable mass, joing swelling, fever
Dx of Ewing’s Sarcoma
Onion Peel, Lytic lesions
Tx of Ewing’s Sarcoma
Chemo, surgery, radiation
What type of neoplasm is Osteochondroma
Most common benign
Dx of Osteochondroma
Xray, pedunculated, grows away from growth plate
Tx of Osteochondroma
Observation
Resection if sx
What type of neoplasm is Paget’s Disease
Benign
Abnormal bone remodeling
What is Juvenile Rheumatoid Arthritis
Autoimmune mono or polyarthritis in children under 16yrs
What are 3 types of Juvenile Rheumatoid Arthritis
Pauci-Articular: Oligoarticular
Systemic: Acute fever, JIA, daily arthritis
Salmon colored migratory rash
Polyarticular: At least 5 small joints affected, increased risk of iridocyclitis (eyes)
Tx for Juvenile Rheumatoid Arthritis
NSAIDS, Corticosteroids, Methotrexate, Eye Exams
How do you tx Scoliosis
Observation for most
Bracing if 20-40 degrees
Surgery if >40 degrees
Dx for Avascular Necrosis
Hip Xray is initial study: results depend on progression of disease
Normal joint space widened to stress fracture to epiphyseal fragmentation to bony destruction
Hip MRI is preferred
