11. Locomotor + 12. Nutrition Flashcards
What age does septic arthritis typically occur?
-Young children - half of cases present in first 2 years
-Twice as common in males
What causes septic arthritis?
-Osteomyelitis (neonates) - spreads via transphyseal vessels
-Haematogenous spread of infection / direct inoculation
-Infected skin wounds eg staph aureus, GBS, GAS
-Underlying joint disease (mostly lower limb)
How does septic arthritis present differently in different age groups?
-Hot, warm, swollen joint
-Inability to weight bear
INFANTS
-Typically do not appear systemically ill
OLDER CHILDREN
-Systemic symptoms - fever
-Acute onset
-Decreased range of movement + pain on passive movement
How should you investigate septic arthritis?
JOINT ASPIRATION (most useful)
-Synovial fluid gram stain + culture
Bloods
Imaging
-USS
-XR - widened joint space suggests effusion, may see late signs on subluxation / dislocation / erosive changes
-MRI to exclude osteomyelitis
-Bone scan if multiple sites
LP - only if H influenza is causative organism (risk of meningitis)
How should septic arthritis be managed?
-IV cefuroxime / vancomycin for 3 weeks followed by oral for a further 4-6 weeks
-Surgery if recurrent / hip involvement
-Physio to avoid joint stiffness
-Usually a good prognosis unless diagnosis is delayed
-10% recurrence so follow up is needed
What happens in developmental dysplasia of the hip compared to a normal hip?
-Normally, the femoral head fits firmly into the acetabulum socket
-In DDH, the acetabulum is shallow so does not adequately cover / secure the femoral head
-Can develop from birth, more common in left hip
-20% of cases are bilateral
What risk factors are there for DDH?
-Female sex
-Swaddling baby
-Breech position
-FHx
-First born
-Oligohydramnios
-High birth weight
How does DDH present?
-Delay in walking
-Waddling gait
-Shortened affected leg
-Hips examined on day 1 and at 6 weeks:
–BARLOW TEST = hips flexed and pressed down with finger over trochanter (would dislocate)
–ORTOLANI TEST = hips flexed and abducted (relocate a dislocated hip)
-Most fix themselves by 3-6 weeks
How would you managed DDH?
-Double nappies for 3 weeks
-Brace with Pavlik harness for 3 months if no suxxess
-Older children may require surgery
-Long term risk of OA, lower back pain
What causes irritable hip?
-Transient synovitis
-Acute hip pain associated with viral infection
-More common in boys aged 2-10
How does irritable hip present?
-Can vary from slight limp / difficulty weight bearing
-No systemic symptoms
-Single joint pain, no pain at rest
-Hx of viral URTI
-Normal Xray, raised CRP, USS may show effusion
How should irritable hip be managed?
-NSAIDs and rest - should resolve in 2 weeks
-If significant physical signs or ? infection refer to orthopaedics
What causes reactive arthritis and how does it present?
-Most cases follow a viral illness especially dysentry or STI
-May be part of Reiter’s syndrome (uveitis, urethritis, arthritis)
-Treat with NSAIDs
What is juvenile idiopathic arthritis?
-Joint inflammation lasting at least 6 weeks in <16s
-Associated with HLA-DR4
-May be:
–Oligoarticular (up to 4 joints)
–Polyarticular (>4 joints)
–Still’s Disease (systemic with fever, rash, uveitis, weight loss)
What biochemical changes would you expect to see on blood results in JIA?
-Increased WCC, ESR, CRP
-Negative rheumatoid factor
-Positive antinuclear factor (70% of polyarticular JIA)
How should JIA be managed?
-Mild exercise + rest each day, hot baths, NSAIDs
-Physio + splints
-Long term –> methotrexate, corticosteroids
-Resolves spontaneously in 80%
What can cause a limp in a child?
-Growing pains
–Worse at night, pain in muscle not bone
-Irritable hip
-Septic arthritis
-Osteomyelitis
–Fever, diagnosed by radiography
-Perthes disease
–Necrosis of femoral head leading to fracture, sometimes following irritable hip
-Slipped capital femoral epiphysis
–Typically in overweight teenage boys, gradual onset
-JIA
-Neoplastic disease
-Trauma
-Osgood Schlatters
–Active children
What is Perthe’s disease?
-Osteochondritis of the femoral head
-Typically occurs in 4-8 year-olds
-Caused by / can develop into avascular necrosis of femoral head
How does Perth’s disease present?
-Progressive hip pain
-Reduced range of movement
-Leg length discrepancy, limp
-Widened joint space on Xray
How should Perth’s disease be managed?
-If good appearance on imaging –> non-weight bearing callipers
-If poor appearance + >6 –> surgery
How does a slipped upper femoral epiphysis present?
-Arthralgia
-Limp
-Restricted ROM
-Externally rotated hip. may be slightly shorter than the other, presents similarly to neck of femur fracture
How should a slipped upper femoral epiphysis be managed?
-Surgical fixation + closure of epiphysis
-Bed rest + analgesia
-May lead to chondrolysis and AVN
What is a normal calorie requirement for a child?
0-1yr = 110kcal/kg/day
1+ = 1000 + ageX100kcal/day
150ml of milk = 110kcal
What can cause malnutrition?
-Diet low in protein, energy, micronutrients
-Diseases causing malabsorption
–Severe GORD
–Immunodeficiency
–Chronic infection
–CF
-Eating disorders
