Orthopedics Flashcards
What is Legg-Calvé-Perthes Disease?
syndrome of idiopathic osteonecrosis (avascular necrosis) of the hip
- typically presents as hip pain and/or limp of acute or insidious onset in childreen between 3 and 12 yo (MC 5 - 7 yo)*
- more often white males*
Associations with: obesity, skeletal immaturity, and lower socioeconomic status
Etiology of Legg-Calvé-Perthes Disease
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approximately 10% of cases are familial
Diagnosis of Legg-Calvé-Perthes Disease
demands a high index of suspicion
initial radiographs are often normal
early in the course: bone scans show decreased perfusion to the femoral head, MRI reveals marrow changes highly suggestive of Dx
later in course: radiographs show fragmentation and then healing of femoral head, often with residual deformity
gradual revascularization occurs subsequently
Management of Legg-Calvé-Perthes Disease
Children diagnosed with LCP should be made nonweight bearing and referred to pediatric orthopedist
Treatment focuses on containing the femoral head within the acetabulum through the use of splints or occasionally surgery
What is slipped capital femoral epiphysis?
In SCFE, the femoral epihpysis slips posteriorly, resulting in a limp and impaired internal rotation
the typical patient is an obese child in early adolescence (ie a female who has not yet reached menarche or a male who has not yet reached the 4th tanner stage)
mean age is 12 in girls and 13.5 in boys, near the time of peak linear growth
SCFE is bilateral in 20 - 40% of cases
Diagnosis of slippe dcapital femoral epiphysis
plain radiographs show apparent posterior displacement of femoral epiphysis
like ice cream slipping off a cone
What is an osteoid osteoma?
relatively common benign bone tumor
the proximal femur is the MC site
most patients present in teenage years
clinical manifestations and diagnosis (imaging) of osteoid osteoma
pain is typically nocturnal and aching
responds briskly to NSAID therapy
visible as a lucency with surroundedd cortical thickening on plain radiograph
In children, common causes of hip pathology include…
developmental dysplasia of the hip
transient synovitis
septic arthritis
Legg-Calvé-Perthes Disease
slipped capital femoral epiphysis
less common:
proximal femoral focal deficiency, developmental coxa vara, neuromuscular hip dysplasia, injuries about the hip, arthritides, and tumors
What is developmental dysplasia of the hip?
DDH is a relatively common condition that is defined as abnormal position of the femoral head relative to the acetabulum, results in abnormal growth of the hip
more prevalent in girls…
following breech deliveries or oligohydramnios (deficiency of amniotic fluid), in caucasians and in the presence of positive FH
Diagnosis of developmental hip dysplasia in neonates and infants
US is the imadging modality of choice for Dx in neonates and infants up til 4months
plain film radiography is recommended for older infants beginning at 4 months (when the ossified femoral head can be visualized)
What is acute transient synovitis? (aka toxic synovitis)
MC nontraumatic hip disorder in children 2 - 10 yo
MC in boys and characterized by pain and limited motion of the hip, arising without a clear precipitant and resolving gradually with conservative therapy
Diagnosis imaging of acute transient synovitis
in cases with high clinical suspicion for acute transient synovitis, US may be the initial imaging study. can demonstrate the effusion and guide joint aspiration
joint aspiration is the reference standard in differentiating toxic synovitis from septic arthritis
B/L joint effusion is more suggestive of transient synovitis than septic arthritis
What is septic arthritis?
unilateral joint effusion present in nearly all cases
septic arthritis in children usually in monoarticular; hip MC joint
septic arthritis of the hip is an emergency as destruction of the femoral head can ensue quickly
Diagnosis of septic arthritis
US can aid both in detection of an effusion and guiding needle aspiration
joint aspiration is the reference standard in differentiating toxic synovitis and septic arthritis
ARTHROCENTESIS is required for definitive Dx
What is developmental coxa vara?
coxa vara is defined as an angle less than 120 degrees between the femoral neck and shaft.
- normal femoral neck-shaft angle decreases from 150 degrees in infants to 120 degrees in adults*
- coxa vara deformed elevates the greater trochanter*
What is Osgood-Schlatter Disease?
osteochondritis of the patellar tendon @ tibial tuberosity from overuse (repetitive stress) or small avulsions (due to quadriceps contraction on the patellar tendon insertion into the tibia)
MC cause of chronic knee pain in young, active adolescents
MC males, 10 - 15 yo, athletes with “growth spurts“ (bone growth faster than soft tissue growth, so quadriceps contraction transmitted through patellar tendon to the tuberosity)
Clinical Manifestations of Osgood-Schlatter Disease
ACTIVITY-RELATED KNEE PAIN/SWELLING
painful lump below knee, tenderness to the anterior tibial tubercle
Diagnosis and Management of Osgood-Schlatter disease
Dx: radiographs show prominence or heterotropic ossification at the tibial tuberosity
Management: RICE, NSAIDs, quadriceps stretching
surgery only in refractory cases
usually resolves with time
