Children's orthopaedics - The Limping Child Flashcards
What is a limp?
Abnormal gait commonly due to pain, weakness or deformity
Shorter stance phase on affected limb
What are the more likely causes of limp in 0-5 year olds?
Trauma Transient synovitis Osteomyelitis Septic arthritis DDH JIA
What are some more likely causes of limp in 5-10 year olds?
Trauma Transient synovitis Osteomyelitis Septic arthritis Perthes disease
What are some more likely causes of limp in 10-15 year olds?
Trauma Osteomyelitis Septic arthritis SUFE Chondromalacia Neoplasm
How does antalgic gait present?
Tenderness Reduced ROM Short stance phase Trauma Toddler's fracture Overuse syndrome Infection
How does abductor lurch present?
Trendelenburg sign
Hip dysplasia
Cerebral palsy
How does equinus gait present?
Toe-to-heel gait Hell-cord contracture Cerebral palsy Idiopathic toe walker Clubfoot Neuro exam needed
What might cause a circumduction gait?
Painful foot
Leg length inequality
What are the main culprits in paediatric orthopaedic infection/inflammation?
Transient synovitis
Osteomyelitis
Septic arthritis
Which blood tests are important in paediatric orthopaedic infection/inflammation?
WCC CRP ESR CK Cultures
How does septic arthritis present in children?
Limping Pseudoparalysis Swollen red joint Refusal to move joint Pain Temperature
Which joints are worst affected by septic arthritis?
Knee 37%
Hip 33%
Ankle 13%
What are some blood test results we can expect in septic arthritis?
Raised WCC >12000
ESR >50mm/hr
CRP
What are the kocher criteria for predicting septic arthritis?
Pyrexia >38*C
No weight bearing
WBC >12000/ml
ESR >40mm/hr
More positives = more likely to develop SA
How is septic arthritis treated?
Aspiration
Arthroscopy
Arthrotomy
Antibiotics?
How does osteomyelitis present?
Pain
Fever
Reduced ROM
Reduced weight bearing
Describe the pathogenesis of osteomyelitis?
Vascular loops
Terminal branches
Inhibited phagocytosis (Low pO2)
Trauma
What is surgery used for in osteomyelitis?
Aspiration for culture Drainage of subperiosteal abscess Drainage of joint sepsis Debridement of dead tissue Failure to improve Biopsy in equivocal cases
What are some presenting symptoms of transient synovitis?
Limping Slightly unwell History of viral infection Apyrexial Joint effusion
How are CRP and WCC affected in transient synovitis?
Low CRP
Normal WCC
What are some features in orthopaedic presentation which may raise concern of neoplasm (cancer)?
Night pain Often incidental trauma Stops doing sport/ going out Sweats and fatigue Abnormal blood results- low Hb, atypical blood film, atypical platelets Get a paediatrician/oncology opinion
