genu valgus is normal b/w what ages?
b/w 4-8
Genu varum is normal up until what age?
Bow legs
nl up to age 3
diagnosis and treatment of septic hip in children
- aspiration of joint
- further open drainage if pus is obtained and use of broad spectrum antibiotics
diagnosis and treatment of slipped capital femoral epiphysis?
Xrays are diagnostic and emergent surgical treatment to pin the femoral head back in place
recognizing septic hip in children
seen in little toddlers who have a febrile illness and then refuse to move the hip. They hold their leg w/ the hip flexed and don’t let anybody try to move it passively.
what type of pt. is slipped capital femoral epiphysis normally seen in? classic physical exam findings?
-typically a chubby (or lanky) boy around age 13 that complains of groin (or knee) pain and are noted to be limping.
- limited hip motion
- as hip is flexed it goes into external rotation and cannot be internally rotated
- when legs dangling, sole of affected leg points toward other leg
how to diagnose and treat Legg-Calve-Perthes disease?
- AP and lateral hip xrays showing fissure and necrosis at the epiphyseal plate
- casting (to contain femoral head within the acetabulum) and crutches
treatment of developmental dysplasia of the hip
abduction splinting w/ Pavlik harness for about 6 months
what is developmental dysplasia of the hip?
genetic disorder in which children have uneven gluteal folds and physical exam of the hips shows that they can be easily dislocated posteriorly with a jerk and a “click” and returned to normal with a “snapping”
what is Legg-Calve-Perthes disease and around what age is it normally seen in a pt.?
avascular necrosis of the capital femoral epiphysis…occurs around 6 yrs old w/ limping, decreased hip motion, and hip (or knee) pain.
only areas where children have special problems w/ fractures
supracondylar fractures of the humerus and fractures of any bone that involve the growth plate
mechanism of injury for supracondylar fractures of the humerus? management of these fractures?
- hyperextension of the elbow in a person who falls on the hand w/ the arm extended
- casting w/ careful monitoring of vascular and nerve integrity and watching for development of compartment syndrome
management of fractures that involve growth plate
- if growth plate is in one piece: closed reduction (cast)
- if growth plate is in two pieces: precise alignment needs to be provided by open reduction and internal fixation (surgical reduction and fixation)
primary malignant bone tumors…what population? symptoms? diagnosis? treatment?
- affects young people (children and young adults)
- persistent low grade pain occurring for months
- Xray will show invasion into adjacent soft tissues w/ a “sunburst” pattern or periosteal “onion skinning” depending on which type
- treatment: highly specialized and left to expert oncologists
most common primary malignant bone tumor? where is it commonly seen? pattern seen no xray?
- osteogenic sarcoma
- lower femur or upper tibia
- sunburst pattern
Ewing sarcoma: where do they grow? pattern on xray?
- diaphyses (shaft) of long bones
- onion skinning pattern
soft tissue sarcomas: characteristics? commonly met. to where? diagnosis? treatment?
- firm, fixed to surrounding structures which grows w/in several months
- MRI can show malignancy but biopsy is diagnostic
- wide local excision, radiation and chemo
- metastasize to lung NOT lymph nodes
general management for adult fractures
if broken bones are not badly displaced or angulated or can be satisfactorily aligned by external manipulation should undergo closed reduction (cast). If not then open reduction and internal fixation (surgery)
management of clavicular fracture
place arm in sling
posterior shoulder dislocation: mech. of injury? diagnosis?
- rare; usually happens after massive uncoordinated muscle contractions, like epileptic seizure or electrical burn
- axillary views or scapular lateral views of xrays
colles fracture: mech. of injury? treatment?
- fall on an outstretched hand (usually in osteoporotic ppl).
- closed reduction and long arm cast.
Fracture of the scaphoid: mech. of injury? diagnosis? treatment?
- falling on outstretched hand
- diagnose w/ Xray
- –if not initially displaced: then xray will be negative so give thumb cast if history is good and physical shows tenderness over snuff box
- –if initial Xray is displaced and angulated: open reduction and internal fixation are needed.
metacarpal neck fractures: usual mechanism of injury? diagnosis? treatment?
- closed fist hitting a hard surface (4th or 5th fingers typically damaged)
- Xray for diagnosis
- treatment depends on degree of angulation, displacement, or rotary malalignment:
- –closed reduction and ulnar gutter splint for mild ones
- –Kirschner wire or plate fixation for bad ones
Hip fractures: mech. of injury? diagnosis? treatment?
- falling down by older person
- pt’s position in a stretcher w/ affected leg being shorter and externally rotated as a clue and Xray as confirmed diagnosis
- treatment depends on specific location
