others Flashcards
risk factors DDH? age?
infant
female, macrosomia, oligo hydramnios, first child, family history
investigations DDH
clinical - clunking, asymmetrical skin folds Barlow and ortolani galeazze test USS <4m xray >4m
management DDH
pavlik harness <6m
CR + spica cast >6m
OR + spica cast 6-18m
osteotomy + OR + spica cast 2y
symptoms of compartment syndrome
disproportionate pain - pain out of keeping paraesthesia paresis muscle contracture limb pallor loss of sensation
what is compartment syndrome?
build up of pressure within a closed space (myofascial compartment)
blood flow to muscles and nerves are cut off
management of compartment syndrome
urgent fasciotomy within 1h
causes of Cauda Equina syndrome
compression of the spinal nerve roots lumbar disc herniation spinal vertebral fracture metastases infection
symptoms of Cauda equina
bilateral sciatica leg weakness saddle anaesthesia urinary / fecal incontinence sexual dysfunction
examination findings Cauda Equina
LMN signs - hypotonia, areflexia, muscle weakness, poor anal tone, saddle anaesthesia
ABDOMEN - palpate bladder
investigations cauda equina
MRI
management cauda equina
ABCDE
insert catheter
surgical decompression - laminectomy, discectomy
osteoporosis definition
> 2.5 sd below mean for young adult
examination of osteoporotic patient
inability to weight bear external rotation of limb shortened limb pain on limb rotation bruising (extra capsular #)
important nerve to examine in hip fracture
sciatic nerve
motor function of Ankle, dorsiflexion of great toe
extra capsular femoral fracture stable?
yes, blood supply maintained
intracapsular femoral fracture stable?
no, bloood supply disrupted
risk of AVN / non union
risk with intracapsular femoral head fracture
AVN
non union
management subtrochanteric fracture
cephalomedullary nail
IM / gamma nail
management intertrochanteric humeral head fracture
DHS dynamic hip screw
complications of any hip surgery
pain, bleeding, stiffness, infection
peri prosthetic fracture
anaesthetic risks - CVA, MI, respiratory depression
DVT / PE
complications of THR / hemiarthriplasty
mal union
dislocation
leg length discrepancy
sciatic n. damage
commonest cause of Paediatric hip pain
transient synovitis
commonest cause of septic arthritis
s aureus
N gonorrhoea (12-18)
gonorrhoea sometimes presents with septic arthritis!!!
spread of septic arthritis?
haematogenous
direct inoculation
spread from osteomyelitis
spread from soft tissue infection
investigations in septic arthritis
aspiration gold standard
temperature
bloods - ESR, CRP, WBC
aspirate!!!!!!!! + USS (before Abx)
blood cultures
what criteria is used in septic arthritis?
KOCHER criteria unable to weight bear temp >38.5 WBC >12 ESR >40
CRP >12 also indicative
management septic arthritis
emergency washout in theatre
IV Abx 6 weeks - cefuroxime / cefotaxime
repeat washout
main differential of septic arthritis
transient synovitis
what is transient synovitis
irritable hip
irritation of synovium
what does USS show transient synovitis
hip effusion!
causes of transient synovitis
recent infection eg URTI
allergy
trauma
differentiate between transient synovitis and septic arthtisi
KOCHER - temp, ESR, WBC, CRP,
USS
aspiration
blood supply to femoral head in paediatrics vs adults?
artery of ligament Teres (peads)
retinaculum vessels in adults
risk factors perthes
male
family history
3-12
perthes presentation
unilateral or bilateral decreased ROM - int rotation and abduction intermittent hip or groin pain NO history of trauma painful gait
classification of PERTHES
herring lateral pillar classification
management of perthes
conservative
physio
brace - abduction
traction
what is SUFE
femoral head slips backwards
slippage of epiphysis relative to femoral neck
risk factors SUFE
male 12-15 obese endocrine disorder rapid growth during adolescence
test in SUFE
faber test
flexion, abduction and external rotation of hip causes pain
classification of SUFE
- slippage
- weight bearing
- southwick angle classification
what is salter Harris classification
fracture through growth plate
imaging in SUFE
AP
frog leg lateral (Lowenstein)
treatment of SUFE
in situ pinning
prophylactic pinning of other hip
x ray findings in SUFE
widened physis
decreased epiphyseal height
Kleins line
head shaft angle of southwich
