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MSK > Children's orthopaedics - The Limping Child > Flashcards

Children's orthopaedics - The Limping Child Flashcards

1
Q

What is a limp?

A

Abnormal gait commonly due to pain, weakness or deformity

Shorter stance phase on affected limb

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2
Q

What are the more likely causes of limp in 0-5 year olds?

A 
Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
DDH
JIA
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3
Q

What are some more likely causes of limp in 5-10 year olds?

A 
Trauma 
Transient synovitis 
Osteomyelitis
Septic arthritis 
Perthes disease
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4
Q

What are some more likely causes of limp in 10-15 year olds?

A 
Trauma 
Osteomyelitis
Septic arthritis 
SUFE 
Chondromalacia 
Neoplasm
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5
Q

How does antalgic gait present?

A 
Tenderness
Reduced ROM
Short stance phase
Trauma
Toddler's fracture
Overuse syndrome
Infection
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6
Q

How does abductor lurch present?

A

Trendelenburg sign
Hip dysplasia
Cerebral palsy

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7
Q

How does equinus gait present?

A 
Toe-to-heel gait
Hell-cord contracture
Cerebral palsy
Idiopathic toe walker
Clubfoot
Neuro exam needed
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8
Q

What might cause a circumduction gait?

A

Painful foot

Leg length inequality

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9
Q

What are the main culprits in paediatric orthopaedic infection/inflammation?

A

Transient synovitis
Osteomyelitis
Septic arthritis

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10
Q

Which blood tests are important in paediatric orthopaedic infection/inflammation?

A 
WCC
CRP
ESR
CK
Cultures
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11
Q

How does septic arthritis present in children?

A 
Limping
Pseudoparalysis
Swollen red joint
Refusal to move joint
Pain 
Temperature
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12
Q

Which joints are worst affected by septic arthritis?

A

Knee 37%
Hip 33%
Ankle 13%

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13
Q

What are some blood test results we can expect in septic arthritis?

A

Raised WCC >12000
ESR >50mm/hr
CRP

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14
Q

What are the kocher criteria for predicting septic arthritis?

A

Pyrexia >38*C
No weight bearing
WBC >12000/ml
ESR >40mm/hr

More positives = more likely to develop SA

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15
Q

How is septic arthritis treated?

A

Aspiration
Arthroscopy
Arthrotomy
Antibiotics?

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16
Q

How does osteomyelitis present?

A

Pain
Fever
Reduced ROM
Reduced weight bearing

17
Q

Describe the pathogenesis of osteomyelitis?

A

Vascular loops
Terminal branches
Inhibited phagocytosis (Low pO2)
Trauma

18
Q

What is surgery used for in osteomyelitis?

A 
Aspiration for culture
Drainage of subperiosteal abscess
Drainage of joint sepsis
Debridement of dead tissue
Failure to improve
Biopsy in equivocal cases
19
Q

What are some presenting symptoms of transient synovitis?

A 
Limping
Slightly unwell
History of viral infection
Apyrexial
Joint effusion
20
Q

How are CRP and WCC affected in transient synovitis?

A

Low CRP

Normal WCC

21
Q

What are some features in orthopaedic presentation which may raise concern of neoplasm (cancer)?

A 
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

MSK (26 decks)

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