Musculoskeletal Flashcards
growth plate fractures
can cause permanent deformities. type I: zone of hypertrophic cells of physis with no fx in surrounding bone. type II + metaphysical fragment on compression side (rare growth disturbances with 1&2). type 3: phseal separation with fx through epiphysis. type IV: metaphysics, physis, and epiphysis. type V: compression/crushing to physis. eval throughout a year to assess growth disturbance.
shaft fractures
s/s: failure to bear weight, limp, pain on extremity, deformity, altered function or gait. tx is immobilization. AP/ lateral x-rays and oblique of wrist. assess skin, ROM,
care of casts/splints
splints noncircumferentialz immobilizer to accomodate swelling. casts are circumferential. keep cool, clean, dry; cover with plastic wrap or bag if bathing. if wet, hair dryer on cool. if soiled, clean with slightly damp washcloth. check circulation. after removal: skin delicate/yellow/flaky. soak and gentle cleanse, pat dry, don’t rub or peel. call if poor circulation or neurological.
annular ligament displacement
nursemaid’s elbow. in 6mo-5 years. d/t pulling them by hand or grasping to prevent fall. pain with movement but not palpation/limited supination. if hx not consistent, do x-rays. differential: fracture of elbow/clavicle. if other s/s consider abuse. tx: supination and flexion or pronation; don’t attempt if epitrochlear tenderness since can indicate fx. may need 3 reductions > sling and ortho f-u.
Costochondritis
inflammatory process of costochondral cartilages causing tenderness/pain in anterior chest wall. can be d/t trauma or too much physical effort. sharp/darting/dull pain that radiates, can feel tightness, worsened by coughing deep breathing etc. tender to palpation. swelling. no dx necessary. diff: rib fractures, rheumatic diseases. Tx: mild analgesia and NSAIDs, avoid strenuous activity, cough suppressant. stretching, ice.
Legg-Calve-Perthes Disease
infarction of bony epiphysis of femoral head with avascular necrosis. d/t insufficient blood supply. area revascularizes, necrotic bone replaced but can take 18-24mo. critical point where fx can occur (symptomatic and reabsorption/replacement changes femoral head and interrupts joint. boys > girls, often lower socioeconomic/low birth weight, children 4-8 years.
LCPD s/s
intermittent limp (abductor lurch) after exertion especially, mild/intermittent pain in groin, hip region, or greater trochanter. antalgic gait, atrophy of muscles, pain on rolling leg in, referred to medial of ipsilateral knee, some limited ROM.
LCPD dx/tx
AP pelves and frog -leg lateral views, ultrasonography. can do bone scan/MRI. diff: infections, sickle cell, toxic synovitis, SCFE, osteomyelitis, JIA. tx: surgery
Slipped capital femoral epiphysis
fx through proximal femoral physis d/t stress. may have trauma. just after puberty onset often overweight or skeletally immature boys. African American higher risk. if <10 years, may have hypothyroid, hypo pit, hypogonad, renal osteodystrophy, GH abnormalities.
SCFE s/s
vague hx trauma, pain, limping, overweight, delayed puberty, short leg limp, mild atrophy of muscles, limited abduction/extension.
SCFE dx/tx
dx: plain x-ray AP pelvis, frog leg lateral, true lateral. diff: LCPD, sepsis, osteoarthritis. refer to ortho surgeon, put on crutches/wheelchair for non-weight bearing. needs percutaneous pinning and placement of screw. high incidence contralateral within a year, so monitor until skeletal maturity. partial weight bearing for 4-6 weeks. not preventable. advise weight reduction.
Femoral anteversion
increased anterior angle of head of femur > in toe walking. normal in 3-6y. family hx, sitting in W, awkward run. knees medially rotated. no dx, not harmful. refer if rotation is significant. can do osteotomy if >8y and significant.
Genu Varum
bowed legs; normal until 3 y. pathologic if angle >15 in infants, doesn’t decrease in 2nd year, asymmetric, with short stature, rapidly progressing. if >30mo, may be d/t Blount, rickets, tumor, neuro. dx with AP and lateral x-ray.
Genu valgum
knock knees. improves between 4-6 years. pathologic causes: rickets, renal osteodystrophy, skeletal dysplasia, physical arrest, tumors, infection. s/s: progression, joint pains/ stiff gait, knee pain. unilateral deformity, awkwardness of gait, short stature. dx: rule out pathological cause. tx: if >15 degrees or after 6 years, need surgery.
Osgood-Schlatter
d/t microtrauma in patellar tendon. in adolescents with rapid growth spurt. more often boys 10-15. girls 8-12. recent activity, pain increases after activity and stops when stopping; pain bilateral half cases. can reproduce pain by extending knee against resistance or stressing quads, focal swelling, heat, point tenderness; bony prominence there. diff: knee derangements, tumors, hip problems. self-limiting, avoid activities causing pain, use ice, stretching, NSAIDs short term, neoprene sleeve, wrap, casting for severe cases, don’t overuse.
