Limping child

Question 1

What is a limp

Answer 1

An abnormal gait commonly due to pain, weakness or deformity

Question 2

What is an antalgic gait

Answer 2

Limp associated with pain where there is reduced time in the stance phase

Question 3

What is a trendelenberg gait

Answer 3

Weakness of the muscles causing gait where the upper body swayes

Question 4

What is a toe walk gait

Answer 4

Abnormal gait due to short limb where the child is walking on their toes on one side

Question 5

What is an adducted and loss of rotation gait

Answer 5

Caused by a stiff joint - abnormal gait where the hip is adducted and there is a loss of rotation

Question 6

What are the common causes of limping child in 1-3 year olds

Answer 6

septic arthritis
fracture
DDH - developmental dysplasia of hip
C.P

Question 7

What are the common causes of limp in 4-10 year olds

Answer 7

Transient synovitis
Perthes disease
J.I.A

Question 8

What are the common causes of limp in children over 10

Answer 8

SUFE - slipped upper femoral epiphyses
Spondylolisthesis
Overuse

Question 9

What investigations are done for a limping child

Answer 9

Temperature
Bloods :
WCC
CRP + ESR - inflammation markers
CK - creatine kinase
Cultures

Question 10

What is the Kocher criteria

Answer 10

Differentiation of septic arthritis from other causes of limp

Pyrexia over 38

no weight bearing

WBC more than 12000/ml

ESR more than 40mm/hour

2 positive - 40% septic arthritis
3 positive - 93.1 % septic arthritis
4 positive - 99.6% septic arthritis

Question 11

How does septic arthritis present

Answer 11

Limping

Pseudoparalysis - in very young child

Joint can be swollen and red

Refusal to move joint

pain

pyrexia

Question 12

Which part of the body is septic arthritis most common

Answer 12

lower limb - Knee > hip > ankle

Question 13

How does the infection get into the joint in septic arthritis

Answer 13

Haematogenous spread - infection travels through blood and enters into the joint

Dissemination from osteomyelitis

Spread from adjacent soft tissue infection e.g cellulitis

Question 14

What is the common organism which causes septic arthritis

Answer 14

Staph aureus

Question 15

What is the treatment of septic arthritis

Answer 15

Aspiration of joint - often arthroscopically

Antibiotics penetrate poorly in joints so 2 weeks IV antibiotics and then 4 weeks oral antibiotics

Question 16

Why can osteomyelitis occur in children

Answer 16

There is excess vasculature (vascular loops) around the growth plate where infection can occur

Question 17

What are the symptoms of osteomyelitis

Answer 17

Poorly localised pain

Fever

Reduced range of movement

Reduced weight bearing

Question 18

What is the most common organism that causes osteomyelitis

Answer 18

Staph aureus

Question 19

What are the indications for surgery in osteomyelitis

Answer 19

Aspiration of culture

Drainage of subperiosteal abscess

If the osteomyelitis reaches the joint, the joint needs to be drained out

Debridement of dead tissue

Failure to improve

Biopsu

Question 20

What are the symptoms of transient synovitis

Answer 20

Limping but can weight bear

Slightly unwell

History of viral infection usually

Apyrexia

May not have full range of movement but will allow you to examine the joint

Low CRP and normal WCC

Joint effusion

Often NOT THAT UNWELL

Question 21

What is Juvenile idiopathic arthritis

Answer 21

Persistent arthritis for at least 6 weeks which affects more than 1 joint - all other forms of arthritis have been excluded

Question 22

Who is juvenile idiopathic arthritis more common in

Answer 22

females

Question 23

What is a common complication of pauci-articular juvenile idiopathic arthritis

Answer 23

Inflammation of the eyes which can lead to blindness

Question 24

What are features that raise concerns of neoplasm (cancer)

Answer 24

Night Pain!

stops doing activities

sweats and fatigue

low HB. atypical blood film and platelets