acute limping child Flashcards
what is the most common cause of a limp in children ?
toxic synovitis
what is the most common anatomical region causing limp ?
hip
what is slipped capital femoral epiphysis ?
displacement of femoral head due to growth plate disruption
painful limp - referred pain to thigh/knee
commonly obese, adolescent male
treatment - percutaneous screw fixation
what are the three main conditions causing limp ?
transient synovitis
osteomyelitis
septic arthritis
what are the initial investigations for a limp ?
temperature
xray
USS
bloods
what is the presentation of septic arthritis ?
limping pseudo paralysis swollen, red joint refusal to move joint pain fever
what is the most commonly affected joint by septic arthritis ?
knee 37%
hip33%
what investigations do you do for septic arthritis ?
FBC - raised WCC ESR raised blood culture Xray USS synovial fluid aspirate - WCC >50,000, gram stain, culture
what is the diagnostic criteria for septic arthritis ?
Kocher criteria
what are the tests and grading of Kocher criteria ?
pyrexia >38
weight bearing - no
WCC - >12,000
ESR- >40
0 - <0.2% 1 - 3% 2 - 40% 3 - 93.1% 4 - 99.6%
how do you treat septic arthritis ?
aspiration, arthroscopy, arthrotomy
antibiotics - IV 2 weeks, 6 weeks total
what are the presenting features of osteomyelitis ?
pain localised signs/symptoms fever reduced ROM reduced weight bearing
what are indications for surgery in osteomyelitis ?
aspiration of culture drainage of subperiosteal abscess drainage of joint sepsis debridement of dead tissue failure to improve biopsy in equivocal cases
what are the presenting features of transient synovitis ?
limping, often touch weight bearing history of viral infection apyrexial joint can be examined low CRP, normal WCC may have joint effusion NOT THAT UNWELL
what clinical features raise concern of a neoplasm ?
night pain often incidental trauma stops doing sport/going out sweats and fatigue abnormal bloods - low Hb, atypical blood film, atypical platelets
