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Flashcards in Ortho/rheum Deck (38):
1

Avascular necrosis of the proximal femur epi

2-11 yo Legg–Calvé–Perthes (LCP) disease

Peak at 4-8 yo

2

Avascular necrosis of the proximal femur presentation

Dull ache, throbbing pain localized to groin, alteral hip or buttocks

Pain w// weight bearing activity releived w/ rest

↓ rotation or abduction

Pain, limp, loss of motion

3

Avascular necrosis of the proximal femur tx

Protected weight beating for early stage

Alendronate to prevent early collapse

Cast

4

Avascular necrosis of the proximal femur w/u

MRI * TOC for early etection

Radiography→ crescent sign

5

Congenital hip dysplasia age

4-6 Wk

6

Congenital hip dysplasia presentation

Clicky hip
Barlow and Ortolani

7

Congenital hip dysplasia w/u

U/S

8

Congenital hip dysplasia tx

harness

9

barlow

infant fully relaxed, attempt to dislocate the hip via posterior pressure, adduct the fully flexed hips while pushing the thighs posteriorly

If during this maneuver the femoral head is felt to dislocate or leave the acetabulum → positive

10

ortolani

ID hip that s dislocated,grasp medial aspect of flexed knee w/ thumb fand fully abduct hip → feel for spasm or clunk (not click)

11

Nursemaid elbow age

1-4 yo

12

Nursemaid elbow mechanism

Axial traction on a pronated forearm with elbow in extension→ annular ligament slips over head of radius & becomes trapped in radiohumeral joint

13

Nursemaid elbow presentation

Not using arm, g consistent w/ mech, holding arm close to ody w/ fully extended or slightly flexed elbow and pronated forearm

Pain w/ active supination

No swlling, bony tenderness or deformity

14

Nursemaid elbow tx

Thumb on Osgood-Schlatter disease of radial head and apply gentle traction, supinate forearm and flex elbow

15

Osgood-Schlatter disease epi

Teenage athletes

MC boys

11 yo girls, 13-14 yo boys

16

Osgood-Schlatter disease presentation

Painful knee w/ swelling ver tibial tubercle

17

Osgood-Schlatter disease tx

Stop exercising (curative) or play through it which may cause a palpable nodule

Rest, NSAIDs, ice

Benign course (may last 1-2 yrs)

18

Scoliosis epi

Adolescent (>11 yo) *MC

F>M

19

Scoliosis presentation

Lateral curvature of spine

Truncal asymmetry, school screening or incidental finding

20

Scoliosis tx

Brace if 20-40 deg

Spinal fusion surg if >40 deg

21

Slipped capital femoral epiphysis epi

10-16 yo

M>F

↑ incidence in AA, athletes and obese

22

Slipped capital femoral epiphysis etiology

Weakening of epiphyseal plate of femur → displacement of femoral head

23

Slipped capital femoral epiphysis presentation

Hx of insidious hip, thigh or knee pain associated w/ painful limp

24

Slipped capital femoral epiphysis w/u

Frog leg view**

Lateral radiograph→ post and med displacement of epiphysis

25

Slipped capital femoral epiphysis tx

Pinning in situ

Crutches, avoid weight bearing before and after surgery

26

Juvenile Rheumatoid Arthritis epi

F>M (2:1)

Females onset 1-3 yo
Males onset 8-12 yo

27

Juvenile Rheumatoid Arthritis presentation

Must be <16 yo and lasts for >6 wk

Chronic synovitis + extra-articular manifestations (fever, rash, weight loss)

28

Juvenile Rheumatoid Arthritis Systemic

AKA Still's Disease

spiking fevers, myalgias, polyarthralgias, hepatosplenomeg, lymphadenopathy, leukocytosis, oericarditis, myocarditis

29

Juvenile Rheumatoid Arthritis Pauciarticular

4 or less medium to large joints involved, at risk for asymptomatic uveitis

30

Juvenile Rheumatoid Arthritis Polyarticular

resembles adult RA w/ symmetric involvement and involved 5 or more of small and large joints, low-grade fever, fatigue, rheumatoid nodules and anemia

31

Juvenile Rheumatoid Arthritis w/u

10-15% of pts have + RF or anti-CCP Ab

ESR and CRP ↑ or nrml

ANA may be ↑ for pauciarticular type and indicates risk for uveitis

imaging studies

32

Juvenile Rheumatoid Arthritis tx

NSAIDs and physical and occupational therapy are most beneficial

Methotrexate or leflunomideas secon line early on if no improvement with NSAIDs

Monitor for growth abnormalities, nutritional deficiencies and school/social impairment

33

Osteosarcoma presentation

distal femur pain (or prox tib pain)

xray sunburst

34

Osteosarcoma tx

resection

35

Best radiographic test for bone tumors

MRI

36

best diagnostic test for bone tumors

Bx

37

Ewing's Sarcoma presentation

mid-shaft pain

x-ray shows onion skin

38

Ewing's Sarcoma tx

resection