Orthopedics – Pediatrics
1. What are symptoms of osteomyelitis?: - bone pain
- limping
- fever
- pain and tenderness at infection site
2. What is one of the MC organisms for osteomyelitis?: - MRSA, which may include serious
life and limb threatening complications
3. What appears on labs with osteomyelitis?: - leukocytosis
- elevation of ESR
- C-reactive protein (CRP)
4. What is the location of hematogenous osteomyelitis?: - bone marrow in the metaphysis
5. What is hematogenous osteomyelitis caused by?: - bacterial hematogenous spread into the
bone
6. What type of injury can cause hematogenous osteomyelitis?: - penetrating trauma
7. What does hematogenous osteomyelitis cause as the infection progresses?: -
,edema
- elevates periosteum due to pressure from pus, which can drain/rupture
8. What is dead bone cortex called? (important): - sequestrum
9. What is new bone called? (important): - involucrum
10. What type of imaging is obtained for hematogenous osteomyelitis?: 1. Routine
x-rays obtained
2. MRI or bone scan obtained at a LATER time
11. How is hematogenous osteomyelitis treated?: 1. Aspiration of metaphysis and await culture
2. Tailor antibiotics to bacteria -> Empiric treatment for Staph
3. IF advanced infection or MRSA:
- Antibiotics continued until NO evidence of residual infection
- Surgical debridement for metaphyseal abscesses; multiple abscesses may be necessary
12. What is a septic joint?: - infection in the joint
13. What symptoms can a septic joint cause?: - pain
- limping
- refusal to move the joint
- effusion
,14. What is the most important consideration with a septic hip?: - it is a unique surgical
emergency requiring urgent surgery
15. What is a septic hip caused by?: - typically follows an URI by 1 week or more
- hematogenous spread of bacteria
16. How is a septic hip diagnosed and how can you determine which organism?-
: 1. Definitive diagnosis = arthrocentesis with aspiration and synovial fluid analysis
2. IF synovial WBC count is 50,000/uL -> N. gonorrhoeae
- IF synovial WBC count is >250,000/uL -> Staph aureus
17. WHat do synovial WBCs damage?: - the articular cartilage
18. What position do children usually hold their hip in with septic hip? (impor-
tant): - child holds the affected hip in flexion, abduction, and external rotation to relieve the pressure and pain
19. What appears on imaging studies for septic joints?: - X rays are usually normal or may
show nonspecific signs of effusion or local tissue swelling
- MRI shows effusion or concurrent osteomyelitis or myomyositis
, 20. How are septic joints treated?: 1. Drainage of the joint by ORTHO
2. IV antibiotics, followed by oral antibiotics once the temperature, ESR, and WBC counts are normal
21. What is a true surgical emergency in pediatric orthopedics?: SEPTIC HIP
22. Why is a septic hip a surgical emergency in pediatric orthopedics?: - it can cause
necrosis of proximal femoral epiphysis, and spread to the metaphysis of the femur
23. How is a septic hip treated?: - ASAP surgical drainage by ORTHO
24. Why may a septic hip result in necrosis?: - because extra pressure in the hip joint causes
damage to the blood supply of the femoral head, which is the medial and lateral femoral circumflex arteries
25. What is the usual MOI of puncture wounds of the foot?: - puncture through a shoe by
a nail or sharp object
26. What is the MCO of puncture wounds of the foot?: MCO is Pseudomonas from tennis shoe
rubber surface
- Strep A or Group A Streptococcus may also appear
27. What appears on PE of puncture wounds of the foot?: - redness
1. What are symptoms of osteomyelitis?: - bone pain
- limping
- fever
- pain and tenderness at infection site
2. What is one of the MC organisms for osteomyelitis?: - MRSA, which may include serious
life and limb threatening complications
3. What appears on labs with osteomyelitis?: - leukocytosis
- elevation of ESR
- C-reactive protein (CRP)
4. What is the location of hematogenous osteomyelitis?: - bone marrow in the metaphysis
5. What is hematogenous osteomyelitis caused by?: - bacterial hematogenous spread into the
bone
6. What type of injury can cause hematogenous osteomyelitis?: - penetrating trauma
7. What does hematogenous osteomyelitis cause as the infection progresses?: -
,edema
- elevates periosteum due to pressure from pus, which can drain/rupture
8. What is dead bone cortex called? (important): - sequestrum
9. What is new bone called? (important): - involucrum
10. What type of imaging is obtained for hematogenous osteomyelitis?: 1. Routine
x-rays obtained
2. MRI or bone scan obtained at a LATER time
11. How is hematogenous osteomyelitis treated?: 1. Aspiration of metaphysis and await culture
2. Tailor antibiotics to bacteria -> Empiric treatment for Staph
3. IF advanced infection or MRSA:
- Antibiotics continued until NO evidence of residual infection
- Surgical debridement for metaphyseal abscesses; multiple abscesses may be necessary
12. What is a septic joint?: - infection in the joint
13. What symptoms can a septic joint cause?: - pain
- limping
- refusal to move the joint
- effusion
,14. What is the most important consideration with a septic hip?: - it is a unique surgical
emergency requiring urgent surgery
15. What is a septic hip caused by?: - typically follows an URI by 1 week or more
- hematogenous spread of bacteria
16. How is a septic hip diagnosed and how can you determine which organism?-
: 1. Definitive diagnosis = arthrocentesis with aspiration and synovial fluid analysis
2. IF synovial WBC count is 50,000/uL -> N. gonorrhoeae
- IF synovial WBC count is >250,000/uL -> Staph aureus
17. WHat do synovial WBCs damage?: - the articular cartilage
18. What position do children usually hold their hip in with septic hip? (impor-
tant): - child holds the affected hip in flexion, abduction, and external rotation to relieve the pressure and pain
19. What appears on imaging studies for septic joints?: - X rays are usually normal or may
show nonspecific signs of effusion or local tissue swelling
- MRI shows effusion or concurrent osteomyelitis or myomyositis
, 20. How are septic joints treated?: 1. Drainage of the joint by ORTHO
2. IV antibiotics, followed by oral antibiotics once the temperature, ESR, and WBC counts are normal
21. What is a true surgical emergency in pediatric orthopedics?: SEPTIC HIP
22. Why is a septic hip a surgical emergency in pediatric orthopedics?: - it can cause
necrosis of proximal femoral epiphysis, and spread to the metaphysis of the femur
23. How is a septic hip treated?: - ASAP surgical drainage by ORTHO
24. Why may a septic hip result in necrosis?: - because extra pressure in the hip joint causes
damage to the blood supply of the femoral head, which is the medial and lateral femoral circumflex arteries
25. What is the usual MOI of puncture wounds of the foot?: - puncture through a shoe by
a nail or sharp object
26. What is the MCO of puncture wounds of the foot?: MCO is Pseudomonas from tennis shoe
rubber surface
- Strep A or Group A Streptococcus may also appear
27. What appears on PE of puncture wounds of the foot?: - redness
