Limping child Flashcards
What is a limp
An abnormal gait commonly due to pain, weakness or deformity
What is an antalgic gait
Limp associated with pain where there is reduced time in the stance phase
What is a trendelenberg gait
Weakness of the muscles causing gait where the upper body swayes
What is a toe walk gait
Abnormal gait due to short limb where the child is walking on their toes on one side
What is an adducted and loss of rotation gait
Caused by a stiff joint - abnormal gait where the hip is adducted and there is a loss of rotation
What are the common causes of limping child in 1-3 year olds
septic arthritis
fracture
DDH - developmental dysplasia of hip
C.P
What are the common causes of limp in 4-10 year olds
Transient synovitis
Perthes disease
J.I.A
What are the common causes of limp in children over 10
SUFE - slipped upper femoral epiphyses
Spondylolisthesis
Overuse
What investigations are done for a limping child
Temperature
Bloods :
WCC
CRP + ESR - inflammation markers
CK - creatine kinase
Cultures
What is the Kocher criteria
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
How does septic arthritis present
Limping
Pseudoparalysis - in very young child
Joint can be swollen and red
Refusal to move joint
pain
pyrexia
Which part of the body is septic arthritis most common
lower limb - Knee > hip > ankle
How does the infection get into the joint in septic arthritis
Haematogenous spread - infection travels through blood and enters into the joint
Dissemination from osteomyelitis
Spread from adjacent soft tissue infection e.g cellulitis
What is the common organism which causes septic arthritis
Staph aureus
What is the treatment of septic arthritis
Aspiration of joint - often arthroscopically
Antibiotics penetrate poorly in joints so 2 weeks IV antibiotics and then 4 weeks oral antibiotics
Why can osteomyelitis occur in children
There is excess vasculature (vascular loops) around the growth plate where infection can occur
What are the symptoms of osteomyelitis
Poorly localised pain
Fever
Reduced range of movement
Reduced weight bearing
What is the most common organism that causes osteomyelitis
Staph aureus
What are the indications for surgery in osteomyelitis
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
What are the symptoms of transient synovitis
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
What is Juvenile idiopathic arthritis
Persistent arthritis for at least 6 weeks which affects more than 1 joint - all other forms of arthritis have been excluded
Who is juvenile idiopathic arthritis more common in
females
What is a common complication of pauci-articular juvenile idiopathic arthritis
Inflammation of the eyes which can lead to blindness
What are features that raise concerns of neoplasm (cancer)
Night Pain!
stops doing activities
sweats and fatigue
low HB. atypical blood film and platelets
