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LAST MINUTE EMERGENCY MEDICINE - PART 7

Chẩn đoán: sốt nhẹ và ESR hơi cao có thể có mặt. Kết quả của một cơn sốt đáng kể và ESR gợi ý của một hip tự hoại. Plain phim có thể hiển thị mở rộng không gian chung. Bằng chứng của tràn dịch trên siêu âm | PEDIATRIC ORTHOPEDIC DISORDERS 359 Diagnosis a low-grade fever and slightly elevated ESR may be present. Findings of a significant fever and ESR are more suggestive of a septic hip. Plain film may show joint space widening. Evidence of effusion on ultrasound is more suggestive of a septic joint which can be differentiated from synovitis with arthrocentesis. Management The treatment consists of bed rest and NSAIDs. There is some association with later development of Legg-Calve-Perthes disease see Table 14-26 . TAB LE 14-26 COMMON PEDIATRIC ORTHOPEDIC CONDITIONS DISEASE DEFINITION FEATURES TREATMENT Nursemaid elbow Radial head subluxation Arm held pronated in slight flexion Supination and flexion or hyperpronation Legg-Calve-Perthes Ischemic necrosis of the femoral head Pain limp limited ROM in the 4-8-year-old Confirmed on x-ray treated with NSAIDS rest and physical therapy Slipped Capital Femoral Epiphysis Femoral head slips posterior and inferior to the femoral neck Hip or knee pain limp or limited ROM in the heavy adolescent Non-weight bearing and surgical repair Osgood-Sclatter Tibial tubercle apophysitis Pain and swelling over the tibial tubercle in active young adolescents NSAIDS and rest usually self-limited Septic arthritis Infection in the joint space Most common in children younger than 4-years-old Fever limp decreased range of motion Knee is most commonly affected Hip next most common held flexed and externally rotated Widened joint space on x-ray elevated ESR CRP and WBC are suggestive but infection cannot be ruled out without synovial fluid gram stain and culture. Treatment is antibiotics and surgery Toxic synovitis Noninfectious inflammation in the joint space most commonly hip Hip pain limp decreased ROM but nontoxic child History of recent URI All studies are normal-diagnosis of exclusion Pediatric Orthopedics FRACTURE TYPES Torus fracture buckle fracture . This is a compression fracture of long bone typically occurring near the metaphysis. The .