treatment of Legg-Calvé-Perthes diseaseConservative treatment: limited weight bearing, physical therapy
・Indicated in:
Young children (< 6 years of age)
Mostly undamaged femoral head
Lateral pillar A classification
・☆Casting and bracing can also be used until femoral head deformity develops or range of motion worsens.
Surgery: femoral osteotomy
Indicated in:
・Older children (≥ 6 years of age)
Extensive damage to the femoral head (> 50%)
Lateral pillar B/C class
・Hip arthroplasty can be considered in adults that develop OA orthopedics国試 HirotoShishido
osteochondritis dissecansX-ray
Initial test
May be normal in early stages
More advanced lesions appear as a subchondral bony fragment surrounded by radiolucency.
MRI
Used for early diagnosis in patients with persistent symptoms and normal x-rays and for precise staging
May show articular cartilage thickening or partial detachment in early stages
complex regional pain syndrome (CRPS)Symptoms usually develop within (☆)4–6 weeks following a trauma
★Burning/stinging pain excessive in duration or severity given the inciting event
Sensory: hyperesthesia and/or allodynia
Vasomotor: hypo-/hyperthermia and/or hypo-/hyperpigmentation of the skin, ★erythema
Sudomotor/★edema: hypo-/(☆)hyperhidrosis and/or edema
Motor/trophic: (☆)↓ range of motion orthopedics国試UWorld step2CK HirotoShishido
radiograph for Slipped capital femoral epiphysis (SCFE)右大腿骨骨端部が大腿骨頸部外側の延長線（Klein線）と交わらない所見がみられる（Trethowan徴候） orthopedics国試過去3回 HirotoShishido
management of plantar fasciitispain control and stretching programs are first-line
indication of fasciotomy四肢の激しい腫脹を呈する外傷や下肢動脈塞栓解除術後の患者が異常な四肢の痛みや痺れを訴えたときは，筋区画症候群を疑い筋区画内圧測定をおこなう。内圧測定は，測定したい筋区画の筋内に針を刺し，圧トランスデューサに接続する。筋区画内圧が30mmHgを超える症例では筋区画症候群を合併する危険性が高く，筋膜切開を考慮する。筋区画内圧が40mmHg以上，拡張期血圧との差が20mmHg以下のときには積極的に筋膜切開をおこなう。 orthopedicsemergency medicine国試過去3年 HirotoShishido
when is the pain worsened in the patients with plantar fasciitisintense pain when walking from rest that subsides as patient continues to walk, worse at end of day with prolonged standing
iliotibial band syndromeOveruse injury of lateral knee that occurs primarily in runners. Pain develops 2° to friction of iliotibial band against lateral femoral epicondyle. orthopedicsUWorld step2CK HirotoShishido
