techniques

Clinically

Unwell / irritable

Fever

Not feeding

Unable to weight bear / limp

Knee pain

Examination

Fever

Limited / painful ROM

Hip held flexed and externally rotated

- maximises volume of capsule

Lab tests

WCC > 12 000

ESR > 40

CRP > 10

Blood cultures

Types

1.  Standard trochanteric osteotomy

2.  Sliding trochanteric osteotomy

3.  Extended trochanteric osteotomy

Standard Trochanteric osteotomy

Epidemiology

Adolescent boys

Ossification

Proximal tibia / primary ossification centre

Tibial tuberosity / secondary ossification centre

- eventually merges with primary ossification centre

Ogden Classification

Type I - Tibial tuberosity ossification only

Issues

1.  More common recently

- more high level sport

2.  High risk of reinjuring knee from instability

- can suffer permanent severe chondral and meniscal damage

3.  Risk of physeal arrest high if bone block across physis

- risk is growth arrest with ACL reconstruction

Epidemiology

Hemarthrosis

- 60% children have ACL tear

Definition

Present with pain but not instability

Types

Traumatic

Degenerative

Different treatment algorithms for each

History

Ulna side wrist pain

- may be worse with rotation

- opening doors and jars

History of trauma

Examination

Local tenderness DRUJ