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Archive for the ‘Week 3 stuff’ Category

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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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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AP Xray of lumbar spine

 This x-ray shows a fracture of a vertebra following a  high velocity road traffic accident. 

The lateral  view nearby shows the extent of the damage to the individual bone.

This is a good case to think about the management of major trauma in general and the risks, management and complications of this serious injury.

You can send in any answers to Dundeebones (who promises not to publish them if you are not sure they are right! ed)

Discussion on management at the end of week2 on DundeeBones.

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