Medicine Notes Orthopaedics Notes
Summary of the common musculoskeletal conditions including presentation, aetiology, pathogenesis and management. Includes tips for the OSCE. Colour-coded by topic. Includes chronic bone diseases, fractures and fracture healing, infections and malignancies....
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Paediatric Musculoskeletal Conditions
Talipes Equinavarus (Club Foot)
Inversion of the foot
Adduction of the forefoot relative to the hindfoot
Plantar flexion
Males> Females
Increased risk if 1st degree relative affected
Two main types
Positional
Postural equinovarus
Normal foot held in abnormal position in utero e.g due to oligohydramnios
Fixed
Congenital (associated with cerebral palsy and spina bifida)
Teratogenic
Also strong association with maternal smoking
Clinical features
Affected foot may be smaller than other foot
Lateral aspect of sole of foot may be keratinized
Calf muscles appear atrophied
If foot looks abnormal whilst lying, scratch the side of the foot. A normal foot will evert, dorsiflex and toes fan
Investigations
AP and lateral views on xray – standing
USS
Management
If positional, deformity can be corrected with passive dorsiflexion
Otherwise
Conservative
Series of plaster casts (ponseti regime)
Surgical intervention
Loosen muscles if necessary
Denis Browne boots used to maintain correct position of foot
Developmental Dysplasia of the hip (DDH)
Compromised a spectrum of disorders including;
Frank dislocation
Subluxation
Unusually shallow acetabulum without actual displacement
Aetiology
Positive family history
Breech position at birth
Female
First born child
Multiple developmental abnormalities (spina bifida, club foot etc)
Restricted perinatal movement e.g oligohydramnios
Pathogenesis
Shallow acetabulum
Femoral neck unduly anteverted
Clinical features
Delayed walking
Limp
Asymmetrical skin creases
Decreased abduction
Leg short and externally rotated
DDH checked for shortly after birth + at 6 weeks
Barlow’s Sign
Stabilise pelvis
Move thighs into mid abduction
If hip unstable, backward pressure on lesser trochanter causes femoral head to slip out of acetabulum
Ortolani’s test
Flex hip and knees to 90
Abduct hips gently applying forward pressure to each femoral head
Positive sign = palpable sensation of femoral head slipping into acetabulum
Investigations
USS if < 3-4 months as cartilaginous sutures don’t show up on xray well
Xray if > 3 months
Management
< 6 months old – conservative treatment with harness to hold hip in flexion and abduction
6 months old – surgical reduction
Complications include
Redislocation
Stiffness
Blood loss
AVN and abnormal growth
Perthe’s Disease
= AVN of the femoral head leading to abnormal growth of the physis and remodeling of the regenerated bone
Boys > girls
Common presentation – 4-8 years
Usually unilateral
Aetiology
Unknown – loss of blood supply to epiphysis
More likely if have positive family history
N.B Blood supply to femoral head = medial and lateral circumflex arteries (from femoral). Obturator via ligamentum teres = greater importance in children
Pathogenesis
Stage 1 = bone death (ichaemia – necrosis)
Stage 2 = revascularization and repair
Stage 3 = distortion and remodeling (important that head remains in acetabulum)
Clinical features
Limp (initially painless)
Pain in groin, often radiating the knee
Decreased movements initially
Later abduction and internal rotation may be limited
May be some muscle atrophy
Investigations
Xray
Flattening of femoral head
May be normal initially so consider DEXA
...
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Summary of the common musculoskeletal conditions including presentation, aetiology, pathogenesis and management. Includes tips for the OSCE. Colour-coded by topic. Includes chronic bone diseases, fractures and fracture healing, infections and malignancies....
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