Summary 2 - MSK Flashcards
Describe acute compartment syndrome
Condition in which the circulation to, and functions of tissues in, closed space are compromised by increased pressure within space
Most common causes are haemorrhages into space by fractures
What are the symptoms and signs of acute compartment syndrome?
Pain which is out of proportion to injury, pain on passive stretch, altered sensation, weakness and swelling
Paraesthesia, pale, pulseless, paralysis and cold
Elevated compartment pressure within 30mmHg of diastolic
What is the treatment for acute compartment syndrome?
Open constriction dressings to skin, treat with emergency fasciotomy of all affected compartments
Describe osteosarcoma
Type of primary bone cancer which mostly diagnosed in teenagers and young adults
MRI is the investigation of choice
What are the symptoms of osteosarcoma?
Pain, loss of function, swelling, pathological fractures, joint effusion, deformity and neurovascular effects
Pain is a deep boring ache which is worse at night
Deep seated mass
What is the treatment for osteosarcoma?
Chemo, surgery and RT
Surgery - lib is salvageable in most cases
Describe metastatic bone disease
Secondary bone tumour which is 25x more common than primary
Bone is most common site for metastasis
Site is vertebrae> proximal femur> pelvis> ribs> sternum> skull
What are the 7 most common primary cancers which metastasis to bone?
Lung, breast, prostate, kidney, thyroid, GI tract and melanoma
What is the treatment and management for metastatic bone cancer?
Prevention of pathological fracture - embolization and conservatively if non-weight bearing part
Prophylactic fixation
RT, chemo and surgery
Describe developmental dysplasia of the hip (DDH)
Hip joint is misaligned due to ball + socket of hip joint not being fully developed correctly leading to instability
More girls affected and left hip is more common
What are the symptoms and signs of developmental dysplasia of the hip?
Ortolani’s sign, Barlow’s sign, hamstring sign and piston motion sign
Can lead to pain, OA of hip and back, and limp
What is the management and treatment for DDH?
Under 3 months - Pavlik harness
Closed reduction and spica cast
Over 1 - open reduction and capsule reefing
Over 18 months - open reduction and femoral shortening
Describe Perthes disease
Rare childhood condition where part of the femur dies due to lack of blood supply - collapse of bone
Pathological AVN of hip
More males and primary school age
What is the symptoms and signs of Perthes disease?
First symptoms is a limp or change in walk
Knee pain on activity, stiff knee joint, systemically well, inflammation of hip and no injury associated to pain
Small sclerotic epiphysis seen on X-ray
What is the management and treatment for Perthes disease?
Maintain hip motion, analgesia and restrict painful activities
Supervised neglect in most cases
Consider osteotomy if over 7 years
Describe Slipped under femoral epiphysis (SUFE)
Affects the physis of proximal femur in adolescents
Classified on magnitude of slip - stable or unstable (can’t weight bear)
More teenage boys affected - many overweight
What are the symptoms and signs of SUFE?
Left groin pain for around3 months, short, externally rotated and possibly painful to weight bear
Externally rotated posture and gait. Reduced internal rotation esp. in flexion
What is the treatment for SUFE?
Stable slips are usually pinned in situ and severe unstable slips are considered for open reduction but high AVN risk
Describe Paget’s disease of bone
Localised disorder of bone turnover which has increased bone resorption followed by increased bone formation - disorganised bone
Strong genetic component
What are the symptoms and signs of SUFE?
Bone pain, bone deformity, excessive heat over Paget’s joint and neurological complications like nerve deafness
Isolated elevation of serum alkaline phosphatase
What is the management and treatment for Paget’s disease?
No need to treat asymptomatic unless includes skull or needs surgical intervention
IV bisphosphonate therapy
Ca and Vitamin D supplements
Physio, OT and aids
Describe Rickets and osteomalacia
Rickets - affects bone development in children
Osteomalacia - similar condition but in adults where epiphyseal plates are closed
Muscle function also impaired from low Vit D
Low Ca, low vitamin D, raised PTH and raised alkaline phosphatase
What are the signs and symptoms of rickets?
Stunted growth, large forehead, odd curve to spine, wide joints, odd shaped legs, large abdomen and sore bones causing waddling
Bones more prone to breaking
What are the signs and symptoms of osteomalacia?
Bone pain, muscle weakness and fragile bones which are more prone to fractures
