ILA 1: infection, inflamm, immunity Flashcards
PC: limp. 4 main diseases and typical age groups
- Development dysplasia of the hip (DDH) 0-5yrs
- Perthes (disease of hip) 5-10yrs
- Slipped capital femoral epiphysis (SCFE) 10-15yrs
- Septic arthritis (under 2yrs)
DDH RFs?
breach, FHx, forceps, twin, oligohydramnios, female, clubfoot, c-section
DDH symptoms
- Waddle
- Limp
- Shortening of affect leg
- Asymmetry of skinfolds around hip
- Cant abduct hip
DDH ix
Screening at 72 hrs and 8wks old: Baby check - Ortolanis (abduct; dislocated?) test and Barlow (adduct; dislocatable?) manoeuvre
DDH mx
Pavlik harness (fabric splint) to keep hip flexed and abducted
Perthe’s PP and prognosis factors
Idiopathic avascular necrosis of capital femoral epiphysis (head) followed by revascularisation and reossification over 18-36 months
>6y bad prognosis (due to reossification), <6y better prognosis
Perthe’s age range and sex preference
- 5-10yrs
- Boys 5:1 girls
Perthe’s symptoms and DD
S&S: insidious hip/ knee pain or limp
Unilateral
O/E:
- Roll test - reduced internal rotation + pain + guarding
- Reduced hip movements (all directions)
DD:
JAI - swelling (perthes no swelling)
Sickle cell anaemia - bilateral
Irritable hip - often diagnosed in case of early stage Perthes’
Perthe’s ix
x-ray both hips (inc. frog views) - top of femur looks white, crescent sign (increased femoral head density, fragmentation)
Perthe’s RFs
LBW, short stature, low SE class, passive smoking
Perthe’s mx
- If hip in good position and no muscle spasm - monitor in out-patients w/ x-rays
- Pain and reduced movement - hospital for rest and skin traction (bandages and weights) +/- hydrotherapy
- Surgery: femoral head needs to be covered by acetabulum to acts as a mould for the re-ossifying epiphysis. This is achieved by maintaining the hip in abduction with plaster or callipers or by performing pelvic/femoral osteotomy
SCFE/SUFE RFs
hypothyroid, growth hormone deficiency, hypogonadism, obese teenage boys
SCFE complication
risk of AVN if not treated promptly
SCFE symptoms and exam findings
Limp or hip pain (may be referred to knee)
Ex: restricted abduction and internal rotation of hip
SCFE ix
Ix: hip x-ray + frog lateral view
SCFE mx
fix with screw to hold it, don’t move it í hopefully bone will re-model
If endocrine disturbance - fix other side too
Septic arthritis cause
- Staph A (haem inf prior to Hib immunisation - multi sites affected)
SA symptoms
- S&S Hallmarks : CRP, ESR, limping, fever, can’t wait bare (4/5 = 99% chance septic arthritis)
- Acute red hot swollen, holding it still. Limp/ referred pain to knee
- Pt. hold knee flexed - can fit more fluid in - likely to have big effusion (hip position = fabour)
- Septic arthritis least likely to occur in knee (joint capsule and metaphysis separate)
SA ix
- ↑WCC ↑ESR/CRP, blood cultures
- USS
- X-ray ?trauma (normal at start of septic arthritis - just increased joint space/ soft tissue swelling)
- MRI ?osteomyelitis
- aspiration under USS = gold standard
SA mx
- Tx: surgical wash out + 6w IV cefuroxime (>3months)
o (IV cefotaxime if <3months - risk of meningitis)
o Aspirate when washing out, don’t aspirate first - Initial immobilisation of joint in functional positive, then mobilisation to prevent deformity
Most common cause of acute hip pain in kids?
Transient synovitis
Transient synovitis DD?
Beware SEPITC ARTHRITIS (similar early presentation) - if suspected do joint aspirate + blood culture mandatory
Transient synovitis symptoms
- Follows/ accompanied by viral infection
- Presentation: sudden onset hip pain or limp.
- No pain at rest, decrease range of movement - particularly internal rotation
- Pain referred to knee
- Afebrile, mild fever, not ill - unlike septic arthritis
Transient synovitis mx and complication
Tx: bed rest (rarely skin traction)
In some cases transient synovitis may develop into Perthe’s
