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