21 Orthopedics

Hip

Dz

Age

Symptoms

Diagnosis

Treatment

DDH

Newborn

clicky hip

US at 4 wks

Harness to line up joints

LCP

6 yo

Slow onset, antalgic gait

Xray

Cast

SCFE

13 yo

growth spurt, fat. Nontraumatic joint pain.

Frog-leg xray

Surgery

SJ

Any

fever, leukocytosis, ESR, CRP, can't bear weight. Pain with movement of leg. Osteomyelits has focal pain.

Arthrocentesis > 50k WBC

IND, Abx

TS

Any

Hip pain, weeks after viral, can't bear weight.

Clx

Supportive

  • DDH: developmental dysplasia of hip

  • LCP: legg calvier perthes

    • path: avascular necrosis

    • Antalgic gait:

_
  • SCFE: slipped capital femoral epiphysis

    • frog leg xray:

    _

  • SJ: septic joint

  • TS: transient synovitis: looks like septic but with less symptoms

Knee

Osgood-Schlatter

  • aka osteochondrosis

  • pt: teenage athletes

  • symptoms: knee pain, tibial swelling

  • diagnosis: clinical

  • treatment: stop sports or work through it (palpable nodule).,

_

Scoliosis

  • path: deformity of spine

  • pt: teenage girl

  • symptoms moderate or severe

    • moderate: cosmetic

    • severe: dyspnea, no room for lungs to expand if ribs come together

  • diagnosis: Adam's test, touch toe, one shoulder higher

  • treatment

    • brace: slow progression, prevent surgery

    • surgery

Cancers of bone

_

Ewing

  • path: translocation 11.22, mid shaft

  • symptoms: focal atraumatic bone pain

  • diagnosis: onion skin X-ray, MRI, biopsy

  • treatment: resection

Osteosarcoma

  • path: rb gene, distal femur

  • symptoms: focal atraumatic bone pain

  • diagnosis: sunburst on xray, MRI, biopsy

  • treatment: resection

Fracture

  • Surgery: open reduction, internal fixation (ORIF). Give if

    • open fracture

    • fracture of growth plate

    • communited fracture

  • Cast if no previous 3 problems

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