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13 Cards in this Set
- Front
- Back
Pridie indications
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Acute chondral injury < 2 cm
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Pridie how-to
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Chondral injury
3-4 mm between holes Sharp edges, go down to bone No weight bearing ~ 4 months |
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Methods for chondral lesions
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Pridie
Mosaic Carbon rods Periosteal flap Chondrocyte transplant ... Bentley et al 2012 - 10 year followup of RCT between mosaic and chondrocyte implantation -> 17 % failure vs 55 % failure favoring chondrocyte implantation. Mean age at surgery 31, average 1.5 surgeries prior to study. |
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Beighton score
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Dig 5 > 90 degrees
Thumb - passive dorsiflexion to the flexor aspect of the forearm Hyperextension elbows > 10 degrees Hands flat on the floor Hyperextension knee 4 out of 9 = laxity |
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Jumpers knee
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Tendinopathy
Eccentric exercise 12 weeks Sclerosing treatment using doppler |
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SCFE
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Slipped Capital Femoral Epifysiolysis
Male Ethnicity Obesity Age 10-15 (avg. 12 yo females, 13 yo males) Southwick classification - I-III, 0-30 degrees, 30-60, 60-90 Acute (Acute on Chronic) - 2 screws Chronic (>= 3 weeks) - 1 or 2 screws 1-2 cm long, from anterior to posterior Bilateral advocated due to 20-40 % chance of bilateral Complications: OA. Hip stiffness. AVN. Infections (rare). Limb-Length Discrepancy |
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Leg-Calves-Perthes
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4-8 yo, > 6 yo = worse prognosis
Male:Femal 5:1 Hereditary Abnormal birth position Second hand smoke Herring classification (alternative is Caterall) - lateral pillar height I - Intact height II - > 50 % of height III - < 50 % of height 4 fazes: Condensation faze (Initial) (3-6 months) Fragmentation faze - easiest to classify acc. Herring Reossification faze Remodulation Duration: years Containment! - abd. orthosis (?), varus osteotomy, pelvic osteotomy Neg. prognostic if lateralization of head Stulberg classification - head deformity => OA |
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DDH
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Development Dysplasia of the Hip
Risk factors: - Breech birth - Female gender - Heredity - Oligohydroamnios Signs: Ortolani/Barlow Galeazzi Skin folds Unstable = 6 weeks treatment Dislocatable = 3 months Pavlik/von Rosen - abducted 70-80 degrees + flexed 90 degrees (frog) Ultrasound - screening + verifying reduction early on X-ray (4 months): Hilgenreiner's line -> acetabular angle < 30 degrees Perkin's line - perpendicular to Hilgenreiner's angle (ossification centre should be medial) Shenton's arc - arc between collum and pelvis Late - tenotomy + cast, osteotomy? Follow for 1 year |
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Osteomyelitis
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4 joints with high risk of septic arthritis due to intraart. physes:
Shoulder, elbow, hip + ankle Unwilling to use extremity + tenderness CRP rises early within 6 hours, SR later - failure to respond within 48 hours - surgical intervention - earlier if in high risk physes Culture - bone biopsy culture has best sensitivity (blood has only 30-50 %) IV - antibiotics until improvement then oral ab 4-6 weeks Pathofysiology: Slow blood flow in physes, low phagocytosis -> hematogeneous spread Bacteria: mostly S.Aureus |
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Clubfoot
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PEVA - pes equinus varus adductus
Ponsetti method - 1 cast/week Correct midfoot cacus -> adductus -> varus and last equinus (usually percutaneous tenotomy at 8 weeks) Talus is the fulcrum Associated with other patholgies: hand anomalies diastrophic dwarfism arthrogryposis tibial hemimelia myelomeningocele |
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Patella dislocations (adolescent)
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First time - MPF-lig. torn, treat with patella stabilizing orthosis for 6-8 weeks and thereafter during exercise. Physiotherapy and strengthen vastus medialis
Check for osteochondral fragment - excise if small or reattach with bioabsorbable nails if larger. Younger = higher risk of large chondral fragment - MRI Risk factors for recurrence: - High Q-angle - - Wide pelvis (female) - - Externally rotaded tibia - - Valgus knee - - Femoral anteversion - Hypoplastic trochlea/lateral condyle - Lax ligaments - Patella alta (Insall-Salvati ratio) Tests: Apprehension test, J-sign, Mobile patella Treatment: Lateral release if patellar tilt, medialization of tuberositas tibiae, MPF-lig. reconstruction (?) |
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Synthetic bone graft substitutes
- Resorption speed & types |
Calcium sulfate (fastest)
Tricalcium phosphate - Norian Hydroxyapatatite (slowest) |
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Bone graft qualities
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Osteoacondyctive (ingrowth)
Osteoinductive (BMP, mesenchymal cells) Structural |