Tricky Orthopedics

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    Tricky Orthopedics

    That being said, let’s go through some commonly tested and easily confused orthopedic entities…

    Salter-Harris Classification

    http://orthoinfo.aaos.org/topic.cfm?topic=A00040

    • Type 1 – Slipped (Physis)
    • Type 2 – Above (metaphysis)
    • Type 3 – Lower (Epiphysis)
    • Type 4 – Transverse all 3
    • Type 5 – Rammed (crush)

    Hand/Wrist injuries

    Scapholunate vs. Perilunate vs. Lunate Dislocation

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    • Mechanism for all 3: forceful extension of the wrist
    • Scapholunate dislocation
      • Space between the lunate and scaphoid widened >3mm
      • Tx: Thumb Spica, refer to hand surgeon
    • Perilunate dislocation
      • Capitate is dislocated dorsally in relation to the lunate
        • Lunate (teacup) is aligned with the distal radius
      • Risk: Median nerve injury, avascular necrosis, compartment syndrome
      • Tx: Hand surgeon consult and prompt reduction
    • Lunate dislocation
      • Lunate displaced and rotated volarly (“Spilled teacup”)
      • Risk: Median nerve injury, avascular necrosis, compartment syndrome
      • Tx: Hand surgeon consult and prompt reduction

    Scaphoid fracture: See Nusbaum’s tribute to Egan’s wrist (http://sinaiem.org/the-matt-egans-wrist-memorial-radiology-pearl/)

    galGaleazzi

    • Middle distal 3rd of radius fracture
    • Associated with dislocation/subluxation of distal radioulnar joint
    • Mechanism: fall on outstretched hand (FOOSH) or direct wrist trauma
    • Risk: AIN (branch of median) injury
    • Tx: ORIF

    Monteggia

    • Proximal 1/3 ulna fracture
    • Associated with radial head dislocation
    • More common in pediatrics (peak 4- 10 years)
    • Risk: PIN (branch of radial) injury
    • Tx: Closed reduction vs. ORIF

     

    Pediatric leg pain

    SCFE. Case courtesy of Dr Hani Al Salam, Radiopaedia.org, rID: 9298

    SCFE. Case courtesy of Dr Hani Al Salam, Radiopaedia.org, rID: 9298

    SCFE (Slipped Capital Femoral Epiphysis)

    • M>F
    • Adolescent males
    • Risk factors: Obesity
    • Symptoms: Groin, thigh or knee pain; may be for weeks to months
    • Findings: Abnormal gait, decreased hip motion, abnormal leg alignment
    • X-ray: Obtain Frog leg view
    • Tx: Percutaneous fixation (at times bilateral)

     

     

    Right AVN. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 8464

    Right AVN. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 8464

    Legg-Calve-Perthes Disease

    • Idiopathic avascular necrosis of the proximal femur
    • M>F
    • 4 – 8 years
    • Symptoms: Insidious onset; may cause painless limp; intermittent knee, hip, groin, or thigh pain
    • Findings: Decreased ROM particularly internal rotation and abduction, gait disturbance, limb length discrepancy
    • Tx: Orthopedic consult for nonoperative vs. operative

     

     

     

    Osgood Schlatter. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7848

    Osgood Schlatter. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7848

    Osgood Schlatter’s Disease (Tibial Tubercle Apophysitis)

    • M>F
    • Boys 12-15 years, Girls 8-12 years
    • Risk factors: jumpers or sprinters
    • Symptoms: anterior knee pain, bilateral 20-30%
    • Findings: Tenderness at anterior knee, enlarged tibial tubercle
    • Tx: RICE, Self-limited
    • Similar to Sinding-Larsen-Johansson Syndrome which is inferior pole of the patella apophysitis found more often in jumpers

     

     

    References (Accessed 1/2/17)

    1. Gaillard, Frank. Salter-Harris Classification. Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification
    2. Watts, Evan. Scapholunate Ligament Injury & DISI. http://www.orthobullets.com/hand/6041/scapholunate-ligament-injury-and-disi
    3. Karadsheh, Mark. Lunate Dislocaton (Perilunate Dissociation). http://www.orthobullets.com/hand/6045/lunate-dislocation-perilunate-dissociation
    4. Jones, Tracy. Monteggia Fractures. http://www.orthobullets.com/trauma/1024/monteggia-fractures
    5. Allen, Deborah. Galeazzi Fractures. http://www.orthobullets.com/trauma/1029/galeazzi-fractures
    6. Souder, Chris. Slipped Capital Femoral Epiphysis. http://www.orthobullets.com/pediatrics/4040/slipped-capital-femoral-epiphysis
    7. Souder, Chris. Legg-Calve-Perthes Disease. http://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease-coxa-plana
    8. Woon, Colin. Osgood Schlatter’s Disease (Tibial Tubercle Apophysitis). http://www.orthobullets.com/sports/3029/osgood-schlatters-disease-tibial-tubercle-apophysitis
    9. McKean, Jason. Sinding-Larsen-Johansson Syndrome. http://www.orthobullets.com/sports/3030/sinding-larsen-johansson-syndrome?expandLeftMenu=true
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