Lightning Lecture – Rhabdomyolysis

Classic triad is rare unless severe.

Diagnosis: CK 5X upper limit of normal + causative factor OR characteristic signs/symptoms OR UA with myoglobinuria

Lightning Lecture – Crystal Arthropathy

Synovial fluid aspiration is gold standard for diagnosis, but not always necessary if the presentation is straightforward with infection unlikely.

• Negatively birefringent = gout
• Positively birefringent = pseudogout
• Presence of crystals does not exclude septic arthritis.

Workup: CBC, CMP, ESR//CRP, uric acid

• Uric acid is not reliable for diagnosis on its own

PEM – Ortho Injuries & Child Abuse

Reference developmental milestones when assessing viability of reported mechanism of injury (ex. 2 mo is unlikely to roll off of a bed on their own).

TEN-4-FACESp Rule for <4 yo – signs concerning for abuse

• Torso, ears, or neck
• Any bruising in 4 months and youngers
• Frenulum, angle of jaw, cheeks, eyelids, or subconjunctivae
• Patterned bruising

Workup: CBC, PT/PTT, CMP (or AST/ALT), amylase (or lipase), UA, tox screen, skeletal survey

• Consider CT Head if concern for head injury

Concerning Fractures:

• Bucket handle fracture
• Posterior rib fractures
• Spiral fracture of long bone
• Skull fracture

Non-Concerning Fractures:

• Buckle fracture
• Toddler’s fracture
• Nursemaid’s elbow
• SCFE

Gonorrhea/Chlamydia Arthopathy

Likely underdiagnosed. Think about this in your young patient with unexplained arthritis.

Consider incorporating GC/chlamydia, HIV, and syphilis testing on select patients who may benefit from testing from a public health standpoint.