HTHSCI 2F03 Lecture Notes - Lecture 9: Transient Synovitis, Brachial Artery, Femoral Head

37 views8 pages

azurekangaroo584

26 Dec 2020

School

Department

Course

Professor

For unlimited access to Class Notes, a Class+ subscription is required.

The Limping Child

Aetiology

 DDH

 Transient synovitis

 Septic arthritis

 Perthes’

 Slipped Capital Femoral Epiphyses

 JIA / Still’s Disease

DDH

 Congenital hip joint deformity in which the femoral head

is or can be completely / partially displaced.

Epidemiology

 Incidence: 1/1000

 Sex: F>M

Predisposing Factors

 FH

 Breach presentation

 Oligohydramnios

Presentation

 Screening

 Asymmetric skin folds

 Limp / abnormal gait

 US is v. specific

Mx: maintain abduction

 Double nappies

 Pavlik harness

 Plaster hip spica

 Open reduction: derotation varus osteotomy

Transient Synovitis: Irritable Hip

 Commonest cause of acute hip pain in children

Presentation

 2-12yrs

 Sudden onset hip pain / limp

 Often following or with viral infection

 Not systemically unwell

 PMN and ESR/CRP are normal

 -ve blood cultures

 May need joint aspiration and culture

 Rest and analgesia

 Settles over 2-3d

Perthes’ Disease

 Osteochondritis of the femoral head 2O to AVN.

Epidemiology

 4-10yrs

 M>F=5:1

Presentation

 Insidious onset

 Hip pain initially, then painless

 10-20% bilateral

 X-rays normal initially

 ↑ density of femoral head

 Becomes fragmented and irregular

 Flattening and sclerosis

 Bone scan is useful

 Detected early and < half femoral head affected

 Bed rest and traction

 More severe

 Maintain hip in abduction c

¯ plaster

 Femoral or pelvic osteotomy

Slipped Capital Femoral Epiphysis

 Postero-inferior displacement of femoral head epiphysis

 10-15yrs

 Two main groups

 Fat and sexually underdeveloped

 Tall and thin

Presentation

 Slip may be acute, chronic or acute-on-chronic

 Acute

 Groin pain

 Shortened, externally rotated leg

 All movements painful

 20% bilateral

 Confirm Dx by x-ray

 Acute: reduce and pin epiphysis

 Chronic: in situ pinning

 Epiphyseal reduction risks AVN

Complications

 Chondrolysis: breakdown of articular cartilage

 ↑ risk c

¯ surgery

123

Unlock document

This preview shows pages 1-3 of the document.
Unlock all 8 pages and 3 million more documents.

Already have an account? Log in

Acute Osteomyelitis

Pathophysiology

 Source: local or haematogenous.

 Organisms

 Staph

 Strep

 E. coli

 Pseudomonas

 Salmonella (in SCD)

 RFs

 Vascular disease

 Trauma

 SCD

 Immunosuppression (e.g. DM)

 Children

 Rich blood supply to growth plate

  usually affects metaphysis

Symptoms and Signs

 Pain, tenderness, erythema, warmth, ↓ROM

 Effusion in neighbouring joints

 Signs of systemic infection

Investigations

 ↑ESR/CRP, ↑WCC

 +ve blood cultures in 60%

 X-ray:

 Changes take 10-14d

 Haziness + ↓ bone density

 Sub-periosteal reaction

 Sequestrum and involucrum

 MRI is sensitive and specific

Management

 IV Abx: Vanc + cefotaxime until MCS known

 Drain abscess and remove sequestra

 Analgesia

Septic Arthritis

Pathophysiology

 Source: local or haematogenous.

 Organisms

 Staph: 60%

 Streps

 Gonococcus

 Gm-ve bacilli

 RFs

 Joint disease (e.g. RA)

 CRF

 Immunosuppression (e.g. DM)

 Prosthetic joints

Symptoms

 Acutely inflamed tender, swollen joint.

 ↓ROM

 Systemically unwell

Investigations

 Joint aspiration for MCS

 ↑↑ WCC (e.g. >50,000/mm3) : mostly PMN

 ↑ESR/CRP, ↑WCC, Blood cultures

 X-ray

Management

 IV Abx: vanc + cefotaxime

 Consider joint washout under GA

 Splint joint

 Physiotherapy after infection resolved

Complications

 Osteomyelitis

 Arthritis

 Ankylosis: fusion

Differential

 Crystal arthropathy

 Reactive arthritis

124

Unlock document

This preview shows pages 1-3 of the document.
Unlock all 8 pages and 3 million more documents.

Already have an account? Log in

Bone Tumours

Bony Mets

 Commonest bone tumours

 Bronchus, thyroid, breast, kidney and prostate

 Usually radiolucent (except prostate which is sclerotic)

 Usually axial skeleton (contains red marrow)

 Present with pain or pathological #

 Path # → internal fixation

 Pain → radiotherapy

Tumour-like Non-neoplastic Conditions

Lesion Clinical Features Location X-ray

Fibrous Dysplasia 0-30

F>M

↑ # risk

McCune Albright’s

- Polyostotic fibrous dysplasia

- Precocious puberty (females)

- Café-au-lait spots

Long bones

Ribs

Skull

Usually mono-ostotic

“Ground Glass” lytic lesion

Shepherds crook deformity of prox. femur

Simple bone cyst <20

Lump migrates down shaft

from original growth plate site.

Prox metaphysis of

humerus or femur

Well-defined lytic lesion

Cortex can fall into cyst → “fallen

fragment”

Aneurysmal bone cyst <30yrs

Pain

MRI shows multiple fluid levels

Fibrous cortical defect

and non-ossifying

fibroma

Children

Non-painful, benign

Spontaneously regress

Dist femur

Prox tibia

Often multiple

Benign Cartilaginous Neoplasms

Lesion Clinical Features Location X-ray

Osteochondroma

(exostosis)

10-20

M>F = 3:1

Commonest benign bone tumour

May be related to previous trauma

Knee Cartilage-capped bony outgrowth

Enchondroma /

Chondromas

10-40

M=F

Ollier Disease = multiple enchondromas

Maffucci Syn = Enchondromatosis + multiple

soft-tissue haemangiomas

Multiple enchondromas have risk of malignant

transformation

Hands

Feet

O sign

- Oval lucencies c

¯ radiodense rim

Endosteal scalloping

Chondroblastoma 10-20

M>F = 2:1

Epiphysis

Knee

Radiolucent with sclerotic border

Malignant Cartilaginous Neoplasms

Lesion Clinical Features Location X-ray

Chondrosarcoma >40

Pain + lump

Arise de novo or from chondromas

70% 5ys

Pelvis

Axial skeleton

Lytic lesion

Fluffy “popcorn calcification”

125

Unlock document

This preview shows pages 1-3 of the document.
Unlock all 8 pages and 3 million more documents.

Already have an account? Log in

Document Summary

Congenital hip joint deformity in which the femoral head is or can be completely / partially displaced. Commonest cause of acute hip pain in children. Osteochondritis of the femoral head 2o to avn. Detected early and < half femoral head affected. Slip may be acute, chronic or acute-on-chronic. Iv abx: vanc + cefotaxime until mcs known. Wcc (e. g. >50,000/mm3) : mostly pmn. Cortex can fall into cyst fallen fragment . Usually radiolucent (except prostate which is sclerotic) Lump migrates down shaft from original growth plate site. Lytic lesion c central nidus and sclerotic rim. Roots leave vertebral column between scalenus anterior and medius. Divisions occur under the clavicle, medial to coracoid process. Plexus has intimate relationship c subclavian and brachial arteries. Median n. is formed anterior to brachial artery. Direct: e. g. shoulder girdle #, penetrating or iatrogenic injury. Leffert classification: open, closed, supraclavicular, infraclavicular, radiation-induced, obstetric, upper, lower, mixed. Loss of extension of cmc joints (finger drop)

HTHSCI 2F03 Lecture Notes - Lecture 9: Transient Synovitis, Brachial Artery, Femoral Head

Document Summary

Get access

Related Documents

HTHSCI 2F03 Lecture Notes - Lecture 22: Osteochondritis Dissecans, Patellar Tendinitis, Navicular Bone