Limping Flashcards
best confirmatory imaging modalities for
Perthe’s disease
Osteomyelitis
Chronic recurrent multifocal osteomyelitis
Malignancy
Radioisotope Bone Scan
Ultrasound
Magnetic Resonance Imaging
for which conditions are they the best confirmatory study
Joint effusion Perthe’s disease Soft tissue infection Soft tissue malignancy Discitis Juvenile Idiopathic Arthritis
CT
Tarsal coalition
Osteoid Osteoma
Spondylolisthesis/Spondylolisis
8 Red flags in a limping child
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
most commonly affected joints of the lower extremity in JIA
knee, ankle
and subtalar joints.
Neoplasms for consideration in a limping child
- metastatic lesions in kids less than 5 yrs
- older kids
- neuroblastoma or leukaemia
2. lymphomas and Hodgkin’s disease
Common benign bone tumours
unicameral bone cysts, aneurismal bone cysts, fibrous dysplasias, osteoid osteoma and eosinophilic granulomas
Childhood Discitis
most common in the lumbar region in children younger than 5 years
- Typically Toddlers’ fractures involve the … or …
2. What is seen on radiographs?
- tibia or calcaneus
2. subtle spiral fractures seen on radiographs
Discoid meniscus is a rare human anatomic variant that usually affects the … meniscus of the knee
lateral
Transient Synovitis of the Hip Joint
- most common cause of lower extremity pain and an antalgic gait when
secondary … - presentation: age and onset of pain?
- associated with …
- what does it mimic?
- an irritable hip joint
- age of 3-8 years and manifest with rapid onset of hip pain
- a history of a preceding viral illness
- can mimic septic arthritis (ORTHOPEADIC EMERGENCY) but luckily rarely have a temperature above 38 degrees Celsius
If unsure admit child and monitor
Osteochondritis Dissecans
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
Legg-Calve Perthes Disease
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
Legg-Calve Perthes Disease
Physical exam demonstrates decreased … and … rotation of the hip
abduction and internal rotation
Overuse syndromes causing pain
- Osgood-Schlatter disease
- Sever disease
- Osgood-Schlatter disease
2. calcaneal insertion of the Achilles tendon
Slipped Capital Femoral Epiphysis
- typical patient profile
- physical exam findings
- slipped epiphysis is at significant risk for …
- overweight adolescents just prior to the growth spurt. It is more
common in males - Trendelenburg gait with external
rotation at the hip - 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.
Developmental Dysplasia of the Hip
disorder causes a painless limp in the toddler and it is important to realize that there is no developmental
delay
Unilateral DDH the child will have a … and may exhibit one sided toe-walking (Equines
Gait)
leg length discrepancy
Bilateral DDH the child will have a … and walk with a waddle (Bilateral Trendelenburg
Gait)
swayback appearance
Charcot-Marie-Tooth Disease
A hereditary motor sensory neuropathy (HMSN) that has two forms resulting in muscles weakness and sensory
changes
Charcot-Marie-Tooth Disease
Orthopaedic manifestations
pes cavus o hammer toes o hip dysplasia o scoliosis o Steppage or Dropfoot gait (Limp)
