Lecture 29 The Limping Child Flashcards
What is a limp?
Abnormal gait commonly due to pain, weakness or deformity
What type of gait would a pain associated limp have
Antalgic gait
What type of gait would a weakness associated limp have
Trendelenburg gait
What type of walk would a short limb produce
Toe walk
Name the 11 causes of limps in children
Trauma Infective/inflammatory Neoplastic Neurological Endocrine Degenerative Vascular Idiopathic/Iatrogenic Metabolic Congenital Occupation
What are the clinical prediction rules of septic arthritis (Kocher Criteria)
Pyrexia
No weight bearing
WBC count >12,000/ml
ESR >40mm/hr
What are the clinical presentations of Septic arthritis
- Limping
- Pseudoparalysis
- Swollen, red joint- late sign
- Refusal to move joint
- Pain
- Temperature
Where does septic arthritis commonly occur
Knee
Name 4 routes by which bacteria can reach the joint in septic arthritis
Haematogenous route
Dissemination from osteomyelitis
Spread from an adjacent soft tissue infection
Penetrating damage by puncture or trauma
How is septic arthritis treated?
Aspiration Arthroscopy Arthrotomy Antibiotics IV- 2 weeks Oral- 6 weeks
What are the 3 factors of the pathogenesis of acute haematogenous osteomyelitis
Vascular anatomy
Cellular anatomy-inhibited phagocytosis (low pO2)
Trauma
Whats the most common causative organism of Acute Haematogenous Osteomyelitis
Staph aureus
Name the clinical features of transient synovitis
Limping Slightly unwell Viral infection history e.g. URTI/ear infection Apyrexial Low CRP Normal WCC
Name features that raise concern of a Neoplasm
Night pain
Stops doing sport/going out
Sweats and fatigues
Abnormal bloods- low Hb, atypical blood film, atypical platelets
