Limping

Question 1

best confirmatory imaging modalities for

Perthe’s disease
Osteomyelitis
Chronic recurrent multifocal osteomyelitis
Malignancy

Answer 1

Radioisotope Bone Scan

Question 2

Ultrasound
Magnetic Resonance Imaging

for which conditions are they the best confirmatory study

Answer 2

Joint effusion
Perthe’s disease
Soft tissue infection
Soft tissue malignancy
Discitis
Juvenile Idiopathic Arthritis

Question 3

CT

Answer 3

Tarsal coalition
Osteoid Osteoma
Spondylolisthesis/Spondylolisis

Question 4

8 Red flags in a limping child

Answer 4

Night pain
• Fever and night sweats
• Constitutional upset
• Pallor, bruising, lymphadenopathy and
hepatosplenomegaly
• Anaemia and thrombocytopaenia
• Arthritis with leg length discrepancy or
contracture suggests JIA
• Back pain
• Certain patterns of injury are suggestive
of non-accidental injury

Question 5

most commonly affected joints of the lower extremity in JIA

Answer 5

knee, ankle

and subtalar joints.

Question 6

Neoplasms for consideration in a limping child

1. metastatic lesions in kids less than 5 yrs
2. older kids

Answer 6

1. neuroblastoma or leukaemia

2. lymphomas and Hodgkin’s disease

Question 7

Common benign bone tumours

Answer 7

unicameral bone cysts, 
aneurismal bone cysts, 
fibrous dysplasias, 
osteoid
osteoma and 
eosinophilic granulomas

Question 8

Childhood Discitis

Answer 8

most common in the lumbar region in children younger than 5 years

Question 9

1. Typically Toddlers’ fractures involve the … or …

2. What is seen on radiographs?

Answer 9

1. tibia or calcaneus

2. subtle spiral fractures seen on radiographs

Question 10

Discoid meniscus is a rare human anatomic variant that usually affects the … meniscus of the knee

Answer 10

lateral

Question 11

Transient Synovitis of the Hip Joint

1. most common cause of lower extremity pain and an antalgic gait when
   secondary …
2. presentation: age and onset of pain?
3. associated with …
4. what does it mimic?

Answer 11

1. an irritable hip joint
2. age of 3-8 years and manifest with rapid onset of hip pain
3. a history of a preceding viral illness
4. can mimic septic arthritis (ORTHOPEADIC EMERGENCY) but luckily rarely have a temperature above 38 degrees Celsius

If unsure admit child and monitor

Question 12

Osteochondritis Dissecans

Answer 12

Osteochondritis dissecans is characterized by softened or loose or even separated cartilage and bone on the
articular surface of the joint. Most frequently seen in adolescents. The knee is most commonly affected

Question 13

Legg-Calve Perthes Disease

Answer 13

Idiopathic avascular necrosis of the femoral epiphyses occurring in young children most
commonly between the ages of 4 and 8 years and more common in males

Question 14

Legg-Calve Perthes Disease

Physical exam demonstrates decreased … and … rotation of the hip

Answer 14

abduction and internal rotation

Question 15

Overuse syndromes causing pain

1. Osgood-Schlatter disease
2. Sever disease

Answer 15

1. Osgood-Schlatter disease

2. calcaneal insertion of the Achilles tendon

Question 16

Slipped Capital Femoral Epiphysis

1. typical patient profile
2. physical exam findings
3. slipped epiphysis is at significant risk for …

Answer 16

1. overweight adolescents just prior to the growth spurt. It is more
   common in males
2. Trendelenburg gait with external
   rotation at the hip
3. further slipping and destruction of the vascular supply to
   the head to the femur, once diagnosed the patient should be non-weight bearing and immediately referral to
   orthopaedics.

Question 17

Developmental Dysplasia of the Hip

Answer 17

disorder causes a painless limp in the toddler and it is important to realize that there is no developmental
delay

Question 18

Unilateral DDH the child will have a … and may exhibit one sided toe-walking (Equines
Gait)

Answer 18

leg length discrepancy

Question 19

Bilateral DDH the child will have a … and walk with a waddle (Bilateral Trendelenburg
Gait)

Answer 19

swayback appearance

Question 20

Charcot-Marie-Tooth Disease

Answer 20

A hereditary motor sensory neuropathy (HMSN) that has two forms resulting in muscles weakness and sensory
changes

Question 21

Charcot-Marie-Tooth Disease

Orthopaedic manifestations

Answer 21

pes cavus
o hammer toes
o hip dysplasia
o scoliosis
o Steppage or Dropfoot gait (Limp)