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Archive for February, 2010

The child with  a limp

A.  malignant primary bone tumour

B.  Perthe’s disease

C.  Septic arthritis

D. Developmental dysplasia of the hip

E.  Osgood -Schlatter’s  disease

F.  Slipped upper femoral  epiphysis

Match the following presentations with the most  likely diagnosis above:

1.  an overweight 13 year old boy with  a limp for 3 weeks

2.  a 14 year old boy with a warm hard mass above the knee

3.  a two year old with  painfree limp since starting to walk

4  a 6 year old boy with knee pain and a limp for  2 months

5  a 3 year old girl with a swollen knee and a fever with pain on weight bearing.

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The end of week 3!

Time to review week 3,  we’re more than half way through the MSS course now but  still 2 interesting weeks to go!

Let’s re-cap on week 3 activities.  Most of the week’s  learning can be focused on Wednesday’s patient presentation, Mrs SD with the back pain history.  This presentation and the physical  examination has been backed up in your clinical skills session and by the back pain  lecture (see ppt  of lecture on Discussion Board in ).  The Teaching Materials section in Blackboard has links to all Year 2 musculoskeletal learning resources including case presentation problems and examination videos for each week (next week’s examination video will be on the hip). 

In the Intetraged Teaching  Area section in Blackboard there is poster board material with further examples of clinical problems and management.

Finally, this week’s  Imaging All-sorts  lecture has been a good opportunity to  learn about all sorts of imaging.  Basic and clinical  sciences have been represented by the physiology, microbiology and pathology classes.

So!  Now’s the chance to “Test yersel”!  Have a go at the self assessment questions under the page tag at the top of DundeeBones.

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Skeleton dance

Something to cheer up a cold weekend?

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We haven’t had much of a chance to  look at paediatric orthopaedic problems in the  lecture course so far so it might be useful to highlight some of these clinical problems now.

Top of the list to look at would be:

  • Developmental dysplasia of the hip (AKA congenital dislocated hip [CDH] or congenital hip dysplasia, Ed).  This may present as a clicking hip in a neonate or a limp or dipping hip  in a toddler.  Predisposing factors, clinical  features and management are (well) described in Master Medicine: Surgery, 3ed (2008) Lavelle-Jones & Dent in the library.
  • The next condition NOT TO MISS is infection – either osteitis or septic arthritis.  The differential diagnosis here is with transient synovitis and Perthe’s disease.
  • Finally two developmental  conditions in growing bones that also present with  a  limp in childhood are Slipped Upper (or Capital) Femoral Epiphysis (SUFE) and Osgood-Schlatter’s  disease (a name to conjure with? Ed)

I found this website from the American Academy of Orthopaedic Surgeons easy to  navigate and informative, but remember, you won’t need to know stacks about these conditions.

http://orthoinfo.aaos.org/menus/children.cfm

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If you’d  like to get ready for Trauma in week 5 already then you  might like to look at these links to the AO foundation about fracture management.  AO is  a Swiss group which really dominates the realm of fracture classification and management.  AO has developed an extensive range of fixation devices used worldwide and their approach to the mangement of any fracture is internationally recognised and accepted.

See what you think of these sites and let DundeeBones know if they are any good.  They may be too detailed.

http://lifeinthefastlane.com/2010/02/ao-surgery-reference/

http://www.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwML1yBXAyMvYz8zEwNPQwN3A6B8JJK8gUWAm4GRk6m_oUlwgBFIHr9uP4_83FT9gtyIcgCExWfz/dl2/d1/L2dJQSEvUUt3QS9ZQnB3LzZfQzBWUUFCMUEwOEVSRTAySjNONjQwSTEwRzA!/?showFsk=true

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This  month’s Journal of Hand Surgery (vol 35E) has  a good paper on surgery for the treacherous spiral cord contracture in Dupuytren’s disease.  Good intra-operative photos and nice diagrams. http://jhs.sagepub.com/cgi/content/abstract/35/2/103

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Cutting edge stuff!

I would  like to  start a new category  on DundeeBones which will highlight new advances in  orthopaedic surgery.  I thought this would bring some new advances of interest to our attention.  If anyone has read about or maybe presented somewhere something which they think is a  new  advance or was otherwise interesting then let me know and you can post it in Cutting Edge Stuff.  Two  papers, one on hand transplant and the other on a new leg  lengthening technique will be arriving shortly.  Stay in touch with DundeeBones!

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