wanna bone Flashcards
what is developmental dysplasia of the hip
socket of the hip does not fully cover the head of the femur and femur is at risk of dislocating
what can cause developmental dysplasia of the hip/what are risk factors
anything that decreases the space for the baby in the womb first born oligohydramnios female over 10 pounds other bone deformities breech birth
what are clinical indications of developmental dysplasia of the hip
leg length discrepancy limp barlows sign ortolani's sign piston motion sign hamstring sign
what are barlow, ortolani, piston motor and hamstring signs?
barlow - adduct hip and apply pressure on knee a loose hip will slip out the socket
ortolani - do after barlow, flex hips and knees and put pressure on greater trochanters then abduct, hip may pop back in
piston motion sign - as leg is moved longitudinally it moves and it shouldn’t
hamstring sign - can move thigh to abdomen and fully extend knee
what investigations could you do for DDH
Ultrasound is gold standard
x-ray
US if patient is at risk - family history etc
how do you manage DDH
<3 months - splint/pavlik harness
3-12 months - closed recuction and spica cast
1yr - 18 months - open reduction with capsule reefing
>18 months - open reduction with femoral shortening
>6 + bilateral - don’t operate
10+ - don’t intervene
what is perthes disease
avascular necrosis of head of femur/hip
fragmentation - osteoclasts remove dead bone
re-ossification and healing - osteoblasts lay down new growth models
what are risk factors for perthes disease
primary school aged boy overweight family history low social status 4-12 yrs most common in ages 5-8
how does perthes disease present
groin pain relieved on rest
knee and thigh pain on exercise
stiff hip
What is the blood supply to the hip?
The medial and lateral circumflex arteries.
the artery of the ligamentum teres.
what investigations could you do for perthes disease
X-ray
herring grade - see how much of the head is involved (grade B is worst prognosis)
stulberg classification for ‘roundness’
how could you treat perthes disease
maintain hip motion analgesics splints physio supervised neglect osteotomy can be considered in 7+
what is slipped upper femoral epiphysis
when the head of the femur slips off the shaft at the growth plate
what are risk factors for SUFE
boys
overweight
endocrine abnormalities like hyperthyroidism
what are symptoms of SUFE
pain in groin hip and knee pain inability/painful to bear weight shorter leg inability to internally rotate leg - hip help in external rotation
fuck
this
what investigations could you do for SUFE
X-ray - klein’s line for trehowan’s sign
how can you manage SUFE
surgery to fixate with a screw
splints
don’t try to reduce - might damage blood supply and cause AVN.
what is osteomyelitis
infection of the bone
acute inflammation destroys the bone as well as the bacteria
sequester of bone occurs
can be haematogenous spread, local spread via infection in skin,
can become chronic
what are causes/risk factors for osteomyelitis
sickle cell anaemia HIV TB surgery open fracture immunocompromised diabetes steroids
cba
cba
what are the symptoms of osteomyelitis
in children the joint is usually very sire, reluctance to bear weight, joints held flexed, systemically unwell
in adults the thoracolumbar spine is usually effected causing pain and stiffness
what investigations would you do for osteomyelitis
MRI X-ray US biopsy blood cultures - 3 at peak temps bloods for WBC count, CRP. ESR
how could you manage osteomyelitis
antibiotics
rehydration
analgesics
if severe surgery to debride dead tissues may be needed
when does chronic osteomyelitis come on and how do you manage it
usually presents in 70s
old wounds reopen and can spit out dead tissue and bone
give long term antibiotics
may need surgery where joint is filled with collatamp
may need amputation
what is cauda equina syndrome
compression of the cauda equina
what can cause cauda equina syndrome
lumbar IV disk prolapse tumours trauma infection recent surgery
what are symptoms of cauda equina syndrome
sudden leg weakness
incontinence
bilateral buttock and leg pain
what investigations could you do for cauda equina syndrome
urgent MRI
PR exam for anal tone
CT
how do you manage cauda equina syndrome
operate within 48 hours
what is spinal claudication
compression of spinal nerves
what can cause spinal claudication
prolapsed disk
osteophytes
osteoarthritis
tumours
how does spinal claudication present
pain and tingling on exercise
sensory problems
worse on extension
what investigations could you do for spinal claudication
3CT
MRI
X-ray
how could you manage spinal claudication
treat underling cause - surgical decompression
steroid injection to nerve root or epidural injection
what is scoliosis
more than 10 degrees coronal deviation of spine
what causes scoliosis
abnormalities in vertebral segmentation
how does scoliosis present
visible deviation of spine
more obvious when patient leans forward
what investigations could you do for scoliosis
regular x-rays to look at progress
how can you manage scoliosis
watchful waiting
back braces or casts
surgery
what is paget’s disease of bone
disorder of bone turnover
more new bone and vessels are formed
causes disorganised larger less compact bone with more vasculature
more likely to fracture
what causes paget’s disease of bone
genetics
environment
what are risk factors for paget’s disease of bone
anglo-saxon origin
over 40
how does paget’s disease present
deep constant bone pain usually in long bones, pelvis
nerve deafness
bone deformity
heat over bone
what investigations can you do for paget’s disease
isotope bone scan
x-ray
elevation of serum alkaline phosphatase
how can you manage pagets disease
dont need to treat unless in the skull or in an area requiring surgical intervention
IV bisphosphonates
what is osteomalacia
bones weaken
osteoalacia is term used for adults
what is childhood rickets
weakened bones in children
before the growth plated close
what causes osteomalacia/rickets
insufficient mineralisation
calcium or vitamin D deficiency
what are risk factors for osteomalacia
age
asian
how does osteomalacia/rickets present
bone pain
muscle weakness
increased falls risk
what investigations could you do for osteomalacia/rickets
x-ray for microfractures DEXA serum calcium and phosphate (may be low) serum vitamin D PTH levels
how do you manage osteomalacia/rickets
correct deficiency
what is osteogenesis imperfecta
genetic disorder
type 1 collagen defect
causes brittle bones prone to fractures
what are the different types of osteogenesis imperfecta
type 1 - milder, presents when child starts to walk of in adults
type 2 - lethal by age 1
types 3 and 4 - like 1 but more severe with faster progression and earlier onset blindness
what causes osteogenesis imperfecta
genetic
marfan’s is a risk factor
how does osteogenesis imperfecta present
fragile bones pathological fractures short stature growth deficiency hearing loss easy bruising scoliosis tooth malformation hypermobility blue sclera
g
b
what investigations do you do in osteogenesis imperfecta
US for type 2
X-ray - cortical thinning, cystic metaphyses, osteoporosis, calcifiction
biopsy
Ca in urine
how do you manage osteogenesis imperfecta
surgery to treat fractures, intermedulary nails in children
bisphosphonates
lifestyle advice
genetic counselling
what is osteoporosis
genetic disease
bone reabsorption overpowers bone formation
low bone mass and micro architectural deformation
bones are likely to fracture
what causes osteoporosis
low sex hormones cushing's hyperprolactaemia hypopituitarism rheumatoid arthritis ulcerative colitis chron's malabsorption PPIs
how does osteoporosis present
asymptomatic until fracture
what investigations could you do for osteoporosis
FRAX to assess fracture risk
DEXA scan if FRAX is significant - look at Z score for age group >2.5 below mean = osteoporosis
how can you manage osteoporosis
minimise lifestyle factors - smoking, obesity, steroids, low Ca in diet bisphosphonates correct any hormone deficiency SERMs (block effect of oestrogen) denosumab - safe in renal impairment teriparatide - last resort
what is femeroacetabular impingement
bony deformity that restricts movement of hip
can be cam lesion - the head to neck ratio of the femur is decreased - basically gets fatter
pincer lesion - the acetabulum extends too much over the head
what are risk factors for FAI
active female
RA
marfan’s
how does FAI present
block to movement
painful in some manoeuvres - cam is painful in flexion
groin pain
reduced flexion and internal rotation
what investigations could you do for FAI
X-ray
MRI
positive FABER test
how could you manage FAI
NSAIDs physio arthroscopy open surgery hip arthroplasty/replacement
What is the most common cause of septic arthritis in young people?
Neisseria Gonorrhoea
What is the broad spectrum antibiotics first used in septic arthritis?
flucloxacillin and rifampicin or benzylpenicillin (vancomycin of MRSA)
What is the most unique presentation of osteogenesis imperfecta?
recurrent and inappropriate fractures.
BLUE/GREY SCLERA,
What is the difference between osteoporosis and osteomalacia?
In osteoporosis the bones are pores and brittle. In osteomalacia the bones are under mineralised and soft.
What are the most common fractures in osteoporosis?
Vertebral body compression
Scapula
Femoral head
distal radius
What are key risk factors of osteoporosis?
Females - menopause (oestrogen is protective)
SSRI - depression
PPIs
anti-epileptics.
long term corticosteroids >7.5mg for >3 months
What is FRAX tool?
1st investigation done in osteoporosis - gives result of a percentage of a 10 year probalility of a hip fracture.
Bone mineral density - DEXA scan.
How is bone mineral density measured?
DEXA scans - the reading at the hip is the key one.
T score - average healthy young adult (most important - measured at hip)
Z score - average for their age
What is the definition of osteoporosis?
less than -2.5 T score.
What is the treatment for osteoporosis?
1st line - bisphosphonates - zolandronic acid, alandronic acid, risedronate.
What is cerebral palsy?
A permanent, non-progressive brain disorder causing motor problems.
What is the cause of cerebral palsy?
Damage to the brain before birth or in the 1st 2 years of life.
