Case Files 37-42 (C) Flashcards
Explain antalgic gait
Occurs when the “stance phase” of gait is shortened, usually because of pain during weight bearing
Remember: normal gait consists of two phases (swing and stance, with stance accounting for ~60% of the cycle)
The most common nontraumatic hip pathology in adolescents
Slipped Capital Femoral Epiphysis (SCFE)
Hip pathology will frequently present with pain in the…
groin, thigh, and knee
Pain with internal rotation of the hip
+
External rotation on passive flexion
SCFE
What is the most sensitive mark (on PE) of hip pathology in children
Restricted internal rotation followed by a lack of abduction
The FABER test can find pathology located in the…
SI joint
Fever greater than ___ and ESR gerater than ___ is 97% sensitive for septic hip joint
Fever > 99.5
ESR > 20
Monoarticular with systemic signs (eg, fever)
Think septic arthritis
Children with septic hip joint will often lay with their hip flexed, abducted, and externally rotated
What are the most common pathogens involved in children with septic hip?
< 4 months: GBS and Staph aureus
4 months - 5 years: Staph aureus and Strep pyogenes
Spiral fracture of the tibia that results from twisting while the foot is planted
Toddler’s fracture
Setting = acute limp or change in ambulation
*If the child had a painless limp from the time they learned to walk think congenital dysplasia
Transient synovitis
A self-limited inflammatory response that often follows a viral infection, leading to hip pain in children ages 3-10
Low-grade to no fever, normal WBC, normal ESR
Kocher criteria
Used to assess risk for septic arthritis in children
Four criteria:
- Fever > 101.3
- Nonweight bearing
- ESR > 40
- WBC > 12,00
Purulent aspirate with WBC > 50,000
vs
Yellow/clear aspirate with WBC <10,000
Septic joint
vs
Transient synovitis
Avascular necrosis of the femoral head
AKA Legg-Calvé-Perthes (LCP)
More common in boys than girls
Although any disruption of blood flow to the femoral capital epiphysis, such as trauma or infection, can cause avascular necrosis the etiology of LCP is unknown
Capital Femoral Epiphysis
Growth plate that connects the metaphysis (femoral head) to the diaphysis (shaft of the femur)
Treatment for SCFE
Surgical pinning (do not let them walk after making diagnosis)
33% will develop avascular necrosis and 33% will develop SCFE in the contralateral hip
Pain that wakens a child at night
Suspicious for malignancy
“Growing pains” is a diagnosis of exclusion (it should be considered if the pain is only at night, is bilateral, and if no other pathology is found)
A 6-year-old young boy is brought in for evaluation of a painful hip. He has been limping and not wanting to walk for the past 2 days. He has had no obvious injury. He feels better after taking ibuprofen. He has not had a fever, although he had “the flu” last week. Vitals are normal. Some pain with internal rotation. He walks with a pronounced limp. Can he be sent home?
After getting a CBC and ESR
If they are in normal limits he likely has transient synovitis and can be treated with an NSAID with the expectation of a recovery in a few days
A 6-year-old boy has a 2-month history of slight limp. No PMHx and no medications. Normal vitals, but an antalgic gait and decreased ROM in the L hip (internal). Mild pain on palpation of the anterior capsule on the L side. X-ray shows fragmentation of the femoral head. What is the most likely diagnosis?
Legg-Calvé-Perthes disease
Often a self-healing disorder. Treatment is focused on limiting pain and avoiding functional loss.
Physical exam findings of suprapubic pain and costovertebral tenderness
Suggestive of UTI and most likely acute pyelonephritis
Most common organisms leading to UTIs
E coli
Proteus
Klebsiella
Staph epidermidis
Pseudomonas
Candida
Drugs that are commonly associated with “drug fever”
B-lactams
Sulfa derivatives
Anticonvulsants
Allopurinol
Heparin
Amphotericin B
A rare AD disorder charaterized by fever > 104, tachycardia, metabolic acidosis, rhabdomyolysis, and calcium accumulation in skeletal muscle leading to rigidity
Malignant Hyperthermia
May occur up to 24 hrs after exposure to anesthetic agents such as halothane and succinylcholine
Treatment: discontinue offending agents, supportive therapy (antipyretics, oxygen hyperventilation, cooling blankets, sodium bicarbonate, and dantrolene IV)
