# 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:

![\_](https://i.imgur.com/6jBCf0y.png)

*   SCFE: slipped capital femoral epiphysis

    * frog leg xray:

    ![\_](https://i.imgur.com/YW08LFX.png)
* 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).,

![\_](https://i.imgur.com/kF8OkWt.png)

### 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

![\_](https://i.imgur.com/zRCE2NQ.png)

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
