pg 46 Flashcards
(40 cards)
How can slipped capital femoral epiphysis (SCFE) be defined?
is a condition where the head of the femur (thigh bone) slips off the neck of the bone at the growth plate (epiphysis). It usually occurs in adolescents, especially during growth spurts, and can lead to hip pain, stiffness, and limited movement.
Who is at risk of developing SCFE?
Adolescent males who are obese (single most significant risk factor), African- American, hypothyroid and in their pubertal period (10 to 16 years of age) are at a
higher risk than their non-obese, white, female counterparts.
In case of bilateral SCFE or presentation before 10 years of age, think of metabolic risk
factors: hypothyroidism, panhypopituitarism, hypogonadism, renal osteodystrophy as well as growth hormone abnormalities
what is stable vs unstable SCFE
If patient is able to walk and move with/without crutches
= Stable SCFE.
If he’s unable to bear weight whatsoever =Unstable SCFE.
what causes weaking of the growth plate and slippage in adolscence
During the pubertal growth spurt, hormonal changes result in proliferation of the hypertrophic zone of the physis and hence, weakening of the plate;
accompanied by increased mechanical stress (obesity, rapid growth or trauma), this causes slippage/ displacement of the femoral head.
What is expected to be found on physical examination? in SCFE
▪ Antalgic gait (shorter stance phase where the foot contacts the ground in an
attempt to reduce weight-bearing and hence, avoid pain).
▪ Trendelenburg gait/sign due to weakened
gluteal muscles.
▪ Tendency of child to externally rotate affected
limb when walking.
What are the complications of SCFE?
▪ Avascular necrosis of the femoral head: due to slippage or operative intervention.
▪ Chondrolysis: destruction of articular cartilage Joint space narrowing.
▪ Hip osteoarthritis.
▪ Deformity and leg-length discrepancy.
what is a disease that affects male children age 4-5 have a positive fam history, exposed to second hand smoking , low birth wt
legg calve perthe disease
what is a disease that affects young males age 4-8 with positive fam history, low birth wt, exposed to second hand smoking
legg calve perthe disease
how can perthe be defined
▶ It is idiopathic avascular necrosis of the femoral epiphysis in children.
▶ Diagnosis of exclusion: rule out other causes of AVN, e.g. sickle cell disease, steroid use
What is the underlying pathophysiologic mechanism of Perthes disease (4 stages)?
The main postulated mechanism is compromised blood supply to the epiphysis
1. Bone ischemia & necrosis
2. Resorption of necrotic bone & revascularization
3. Re-ossification
4. Remodeling which can result in either bone healing or residual deformity (femoral head collapse).
What are the x-ray findings in Perthes disease?
▪ Early in the disease course, x-ray can look completely normal.
▪ As the diseases progresses, early signs include: joint space widening (due to effusion), irregularity of the femoral head contour and crescent sign (due to
subchondral micro-fxs).
▪ Late findings are flattening (coxa plana), widening (coxa magna) and eventual collapse of the femoral head.
How is Perthes disease managed?
Important prognostic indicators are the age at presentation and sphericity of the femoral head.
‘ Younger age at presentation (< 6 years) and a preserved ROM imply a good prognosis.
‘ Older age (> 6 years), decreased ROM and a female sex imply a worse prognosis.
oct
▶ Goals of treatment are to preserve ROM and maintain containment of the femoral head
within the acetabulum - 60% of hips do well conservatively (non-operatively).
What can cause AVN of the femoral head?
can be either non-traumatic (check causes above) or traumatic. Femoral neck fx (especially if displaced and with poor reduction) and hip dislocation (especially posterior) are traumatic causes that disrupt the vascular supply (medial femoral circumflex artery) to the femoral head.
▶ Bilateral involvement is higher with non-traumatic causes.
▶ An alcohol consumer or a patient on steroids presenting with groin pain has AVN of
the femoral head until proven otherwise.
What can cause AVN of the femoral head?
▶ It can be either non-traumatic (check causes above) or traumatic. Femoral neck fx
(especially if displaced and with poor reduction) and hip dislocation (especially posterior)
are traumatic causes that disrupt the vascular supply (medial femoral circumflex artery)
to the femoral head.
who are the type of ppl most likely to develop avascular necrosis
An alcohol consumer or a patient on steroids presenting with groin pain has AVN of
the femoral head until proven otherwise.
SLE patients develop AVN due to either vasculitis caused by the disease itself, intravascular thrombosis if the patient is positive for antiphospholipid Abs or due to steroids used to treat SLE.
how would a pt with AVN of femoral head present in early stages
It can be asymptomatic or an incidental finding in the early stages.
▶ The typical presenting symptom is pain that is:
▪Located in the groin or anterior thigh.
▪ gradual in onset.
▪ Exacerbated by weight-bearing.
▪ Initially mild but worsens progressively to be present at rest or at night.
What are the imaging modalities used in hip AVN?
1) Pelvic x-ray is the most appropriate initial imaging modality
2) MRI is the gold standard imaging modality (most sensitive and specific) and can detect changes earlier than x-ray
what signs can u see in MRI in AVN of femoral head
▪ Decreased signal intensity indicative of marrow edema predicting worsening pain
and disease progression. (early finding)
▪ Double-line sign: an outer hypointense line on T1 (bone ischemia) and an inner hyperintense line on T2 (hypervascular granulation tissue) - Diagnostic of AVN.
what is steinberg classification
used to stage hip AVN according to imaging findings.
what are the staged in hip AVN
stage 0- normal
stage 1- normal
stage 2- cystic/ sclerotic changes
stage 3- crescent sign (subchondral microfx and collapse)
stage 4- femoral head flattening /collapse
stage 5- Joint space narrowing
stage 6- advanced degenerative chnages
How is hip AVN treated?
stages 1-2= Conservative, medical treatment, Core decompression with or without bone grafting
stages III and above= Total hip replacement
What is the function of the meniscus?
force transmitter across the knee
shock absorber
secondary stabilizer of the knee joint.
medial vs lateral meniscus
▶ The medial meniscus is larger, wider and C-shaped.
▶ The lateral meniscus is smaller, less open and resembles an incomplete circle.
