Child Abuse

Question 1

What % of Fx’s in children are associated with child abuse?

Answer 1

25% of fractures in children ages 1 year and below, and 10-15% in children younger than 3 years are from child abuse

Question 2

True or False: there is a mandatory reporting law for child abuse in all 50 states.

Answer 2

True

Question 3

How many child abuse cases are reported every year?

Answer 3

3.5 million, 33% were substantiated, giving the incidence at 15 per 1000 children.

Question 4

what percent of fractures secondary to child abuse occur in children under 1 year of age?

Answer 4

50% of fractures secondary to child abuse occur in children younger than 1

Question 5

What are the fracture findings suggestive of child abuse?

Answer 5

Multiple fractures in various stages of healing, posterior rib fractures, bilateral acute long bone fractures, complex skull fractures, and long bone fractures in nonwalking children are suggestive of abuse

Question 6

What is the skeletal survey? When is it used?

Answer 6

screening radiographs of the entire skeleton, is indicated in all children younger than 2 years with any evidence of physical abuse, all children younger than 1 year with evidence of medical neglect, and possibly all children younger than 5 years with a suspicious acute fracture

Question 7

What is septic arthritis?

Answer 7

infections that are caused by spread of bacteria in blood

Question 8

What is the incidence of pediatric osteomyelitis?

Answer 8

1 in 250, relatively common

Question 9

Why does the structure of bone in kids predispose them to hematogenous osteomyelitis?

Answer 9

The structure of the blood vessels of the metaphyseal regions of the long bones predisposes them to infection. Because the vascular loops have sharp angles of curvature and small diameters, the bacteria become clogged and bogged down and starts infection

Question 10

How does hematogenous osteomyelitis spread to the bone?

Answer 10

Physis is a barrier to pus, and rarely does infection invade the epiphysis, but it can go down the medullary canal, out through the outer cortex of the bone, and into the subperiosteal space

Question 11

How does hematogenous osteomyelitis spread to the joints?

Answer 11

In joints like the hip and shoulder, the metaphysis is intra-articular, and so the subperiosteal infections here are essentialy already in the joint.

Question 12

When do radiolucent changes begin during osteomyelitis?

Answer 12

Radiolucent patches in bone and periosteal reactions are visible about 2 weeks after osteomyelitis starts.

Question 13

What is sequestrum?

Answer 13

necrotic infected bone that is walled off by fibrotic tissue

Question 14

Which bacteria is common for osteomyelitis in all age groups?

Answer 14

Staph aureus

Question 15

Which bacteria is common for osteomyelitis in kids < 4 years old?

Answer 15

Streptococcus species

Question 16

Which bacteria is common for osteomyelitis in neonates?

Answer 16

enteric organisms (those native to GI tract)

Question 17

Which bacterial infection is a major cause of osteomyelitis in sickle cell patients?

Answer 17

Salmonella

Question 18

What is the clinical presentation for osteomyelitis in neonates?

Answer 18

Osteomyelitis in neonates may only manifest as generalized irritability or failure to thrive, so it is easy to miss

Question 19

Which tests do you need for suspected osteomyelitis in kids?

Answer 19

Blood cell count, ESR (erythrocyte sedimentation rate), CRP (c-reactive protein) level, blood cultures, radiographs, and possibly aspiration of the bone.

Question 20

What is the difference between ESR and CRP in monitoring osteomyelitis?

Answer 20

ESR and CRP levels are high, but CRP level rises and falls more rapidly in response to treatment, so it is used to see if a treatment is good.

Question 21

Which method of radiographs can you use to measure osteomyelitis in the initial period?

Answer 21

Three phase technetium 99m bone scanning

Question 22

Which method of radiographs can you use to measure osteomyelitis by localizing a subperiosteal abscess?

Answer 22

Ultrasound

Question 23

Which method of radiographs can you use to measure osteomyelitis by visualizing the extend of a bony infection?

Answer 23

MRI

Question 24

What is the recommended treatment for acute homogenously spread osteomyelitis?

Answer 24

6 weeks of treatment with antibiotics, administered intravenously.

Question 25

What are the effects of pus in a joint?

Answer 25

Presence of pus in the joint causes damage to the hyaline cartilage on the joint surface. Cartilage changes occur between 8 and 12 hours after infection. Hyaline doesn’t regenerate well so it needs immediate surgical drainage

Question 26

What are the physical findings in children with acute septic arthritis?

Answer 26

They are sicker than those with osteomyelitis and more likely to have a fever and present with lethargy and are irritable. They can also have recent illness, like ear or throat infection, or have a recent injury. Involved joint is warm, tender, and swollen, the hallmark of septic arthritis is resistance to both active and passive motion. Move the patient’s joint to the position that creates the most volume in that joint, most joints will be in flexion for the most volume

Question 27

Which tests do you need to Dx septic arthritis?

Answer 27

Complete blood count, ESR, CRP, radiographs, and blood cultures, aspiration of the joint is imperative, because analysis of the synovial joint is key

Question 28

What is toxic synovitis?

Answer 28

acute non-bacterial joint inflammation, can appear clinically similar to bacterial sepsis, but can be differentiated on the basis of a normal ESR or CRP level, lack of joint effusion, and/or low white blood cell count in the joint fluid

Question 29

How do you manage toxic synovitis?

Answer 29

Management includes drainage and surgical decompression of the affected joint. Antibiotics can be administered for septic arthritis situations and can be continued for 1-6 weeks