Children’s Orthopaedics - The Limping Child Flashcards
Limp?
Abnormal gait usually due to pain, weakness or deformity
If a limping child is in pain, which type of gait do they tend to have?
Antalgic gait
->maybe think similar to analgesics which are pain meds??
If a limping child is in weakness, which type of gait do they tend to have?
Trendelenburg gait
If a limping child has a shorter limb, which type of gait do they tend to have?
Toe walk
If a limping child has a stiff joint, which type of gait do they tend to have?
Adducted gait and loss of rotation
Most likely causes of a limping child are broken into groups depending on age.
List some of the more likely causes of a limping child aged 0-5yrs.
Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
Developmental dysplasia of the hip
Juvenile idiopathic arthritis
Most likely causes of a limping child are broken into groups depending on age.
List some of the more likely causes of a limping child aged 5-10yrs.
Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
Perthes disease
Most likely causes of a limping child are broken into groups depending on age.
List some of the more likely causes of a limping child aged 10-15yrs.
Trauma
Osteomyelitis
Septic arthritis
SUFE (slipped upper femoral epiphysis)
Chondromalacia
Neoplasm
When in the day are rheumatic conditions the worst?
Worst in the morning and get better as the day goes on
A child that is unable to weight bare is unusual. What will often need to be done as a follow up?
An appropriate investigation
What is elevated in the blood in muscle dystrophy?
Creatinine kinase
Management of septic arthritis?
Immediate drainage and antibiotics
Transient synovitis?
Post-viral infection of the joints
Which criteria can be used to predict how likely a patient is to have sepetic arthritis.
There are four criteria, the more the patient has, the more likely they have to have septic arthritis.
For example, a score of 1 = <3% chance they have it
Score of 2 = 40%
Score of 3 = 93% chance
Score of 4 = 99.6%
Don’t get bogged down by the numbers, this is just to show how much these criteria help with diagnosis.
Okay, so what are the four criteria?
Pyrexia (>38 degrees)
Unable to weight bear
WBC >12,000/ml
ESR >40mm/hr
What is a high ESR indicative of?
Inflammaion