Ortho Flashcards
(13 cards)
What is the treatment for DDH?
Pavlik harness
-Abducts the leg and keeps it in joint
Surgical
-If hip cannot be reduced -> open or closed reduction
Who is at risk of perthes’ disease?
Males Ages 4-10 FHx Lower socioeconomic groups Low birth weight children Delayed bone age
In SUFE where does the epiphysis usually slip to?
Lies posterior and inferior to the femoral neck
Which X-ray view is best for diagnosing SUFE?
Frog lateral is the best view
What is the management of osteogenesis imperfecta?
IV pamidronate to try improve bone strength
Sheffield intramedullary telescoping rods are mainstay of treatment for prevention of deformity and further fracture
Established deformity treated with osteotomy
What is systemic onset JIA?
Systemic onset disease This arthritis is characterized by prominent systemic symptoms. It was previously known as Still’s disease.
Patients present with a swinging fever, plus any of the following features: • Evanescentrash. • Hepatomegaly. • Splenomegaly. • Anaemia. • Lymphadenopathy. • Serositis, especially pericarditis.
The differential diagnosis includes infection and malignancy. Joint involvement may be mild or absent initially.
What 2 congenital conditions are associated with osteomyelitis?
Sickle cell disease
Haemophilia
What is excision arthroplasty and when is it used?
This operation has been mostly superseded by joint replacement. It is still occasionally performed for severe arthritis of the first MTP joint (Keller’s procedure) and also in the hip (Girdlestone’s procedure) if the patient has had an infected joint.
The operation leaves the joint unstable and it may still be painful.
(Not arthrodesis where the joint is fused)
Elevation of limbs post op are very important to avoid swelling since they are in a cast
What methods can be used to achieve this?
Elevation in a Bradford sling (for an arm) or on a Braun’s frame is very important to reduce swelling.
How do you manage bone mets?
Conservative
• Adequate analgesia and splintage.
• Radiotherapy is used frequently for bony
metastatic pain.
• Chemotherapy may have a role in certain
tumours.
• Hormonal therapy is useful in breast disease.
• Intravenous bisphosphonates are now being
used to inhibit osteoclastic resorption of bone.
Surgical
• Intramedullary fixation of long bones is performed for fracture or impending fracture.
• Joint arthroplasty is sometimes used around the hip and shoulder.
• Spinal decompression and stabilization for acute cord compression.
What is osteoid osteoma?
Osteoid osteoma is a painful self-limiting benign bone lesion.
The lesion is uncommon, usually presenting between 5 and 30 years of age.
It is caused by a nidus of osteoblasts located in the cortex of bone, and is usually found in the tibia, spine or femur.
Clinical features
- Patients have intense pain, particularly at night. (Differentiates from most other benign bone lesions which are usually asymptomatic
- Tenderness over the lesion is usual.
- In the spine a scoliosis may be present.
Diagnosis and investigation
- X-ray features show a radiolucent nidus surrounded by a dense area of reactive bone.
- CT scans confirm and accurately locate the lesion
Treatment
-Pain is typically relieved by aspirin.
-CT-guided ablation is now preferred over surgical
excision.
Prognosis
-The tumour is eventually self-limiting.
What are the features of an osteosarcoma on X-ray?
• An ill-defined lesion with an indistinct zone of transition.
• Sclerotic or lytic areas within the lesion.
• Cortical destruction.
• Codman’s triangle (elevation of periosteum).
• ‘Sunray spicules’ (calcification within the
tumour but out of the bone).
What is the most accurate way to confirm a meniscal tear?
Arthroscopy of the knee
