Musculoskeletal Disorders Flashcards
(16 cards)
Developmental dysplasia of the hip management
Most resolve by 3-6 weeks
Pavlik in children younger than 4-5 months
First line <6 months - observe - monitored by USS or X ray
Second line - splint or Pavlik harness, follow up with x ray at 6 months old
Third line - surgery if other fail
Indication for USS at 6 weeks for DDH
Breech presentation at 36 weeks (regardless of presentation at delivery)
Breech delivery
Family history of DDH
X ray is better than ultrasound from 6 months on
Fractures initial management
Oral analgesia for mild-moderate pain
IV opioid for severe pain
Acute stage assessment and diagnostic imaging
Fractures management in the ED
Distal radius - manipulation, below elbow plaster cast or K wire if fracture completely displaced
Femoral shaft - admit
- premature and birth injury - padded splint
- 0-6 months - Pavlik or Gallows traction
- 3-18 months - Gallows traction
- 1-6 years - straight leg skin traction with possible conversion to hip spica case
- 4-12 years - elastic intramedullary nail
- 11 years to skeletal maturity - elastic intramedullary nail supplemented by endcaps, lateral entry antegrade rigid intramedullary nail, or submuscular plating
Juvenile idiopathic arthritis management
Should be managed by specialist
Analgesia
NSAIDs useful for controlling pain and stiffness
Consider weak opioids
IV corticosteroids useful adjunctive agents
DMARDs (oral/SC methotrexate, otherwise sulphasalazine) used when failure to respond to treatment
Juvenile idiopathic arthritis prognosis
Expect good disease control and QOL
Complications - joint damage, anterior uveitis, osteoporosis, growth failure
Osgood-Schlatter disease management
Seen in sporty teens
Pain relief - analgesia, ice pack over tibial tuberosity, protective knees pad
Reassure:
- will resolve overtime until end of growth spurt
- stopping all sport activities is not necessary - reduce and change
If symptoms do not improve or worsen into adulthood then refer
Osteochondritis management
Pain relief
Rest and quadriceps exercise
Sometimes surgery is needed
Acute osteomyelitis management
High dose IV empirical antibiotics (2-4 weeks)
Once clinical recovery switch to oral antibiotics
Affected limbs should be immobilised
Chronic osteomyelitis management
Clinical assessment, staging (Cierny-Mader)
Debridement
IV antibiotics
Rehab
Perthes disease management
4-8 year olds
Self limiting
Surgery indicated for patient that fail to respond to conservative measures (only >6yrs)
Reactive arthritis management
Self limiting
NSAID - pain relief
Steroids - severe
DMARD - ongoing
Rickets management
Calcium deficiency with vit D def - daily calcium and ergocalciferol/cholecalciferol
Pseudo vit D def- calcitriol/alfacalcidol
Dietary - oily fish, egg yolk
Septic arthritis management
Neonate to 3 months - IV cefo
3 months to 5 years - IV ceft
Older than 6 years - IV fluc
Oral step down - coamox, flux
Joint aspiration - to dryness as required
Wash out joint or surgical drain may be needed
Slipped upper femoral epiphysis management
Remain non weight bearing, analgesia, immediate referral
Surgical repair
In situ screw fixed across growth plate
Transient synovitis management
RULE OUT septic arthritis
Self limiting
