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MSK - Phase II > Limping child > Flashcards

Limping child Flashcards

1
Q

What is the differential for a limping child?

A 
DDH (Developmental Dysplasia of the Hip)
Septic arthritis
Perthes disease
Transient synovitis (Irritable hip)
SUFE - Slipped Upper Femoral Epiphyses
Still's disease
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2
Q

What is DDH?

A

Developmental Dysplasia of the Hip
Congenital hip joint deformity in which the acetabulum is shallow which can cause the femoral head to partially or completely dislocate

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3
Q

What are some of the risk factors for DDH?

A

Female
FH
Breach presentation at birth
Oligohydramnios (Deficiency of amniotic fluid)

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4
Q

What is the typical presentation of DDH?

A

Screening at 6 week check (Barlow Vs Ortolani tests)
Asymmetrical skin folds
Limping child/abnormal gait

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5
Q

What investigations can be done for DDH?

A

USS

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6
Q

What is the treatment of DDH?

A 
Dependent on the severity
Need to maintain abduction
Pavlik harness
Plaster hip spica
Open reduction
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7
Q

What is Transient synovitis (Irritable hip)?

A

Self limiting condition in which there is inflammation of synovium of the capsule of the hip joint. Syndrome of hip pain, joint stiffness and a limp/non weight bearing gait.

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8
Q

How does transient synovitis present?

A

Usually 2-12 y/o
Sudden onset of hip pain/limp
Often associated with a viral infection
Systemically well

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9
Q

What investigations can be done for a patient with transient synovitis?

A

Polymorphonuclear leukocytes and CRP normal
-ive blood cultures
May need joint aspiration and culture

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10
Q

What is the treatment of transient synovitis?

A

Rest
Analgesia
Should start to settle in 2-3 days

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11
Q

What is Perthes’ disease?

A

Inadequate blood supply to the epiphysis of the femur causing avascular necosis of the femoral head
Osteochondritis occurs due to AVN (Inflammation of bone/cartilage)

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12
Q

What is the presentation of Perthes’ disease?

A

Usually males
4-10 y/o
Insidious onset of hip/groin pain that becomes painless over time

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13
Q

What investigations can be done in a patient with suspected Perthes’ disease?

A

X rays can be normal initially
Becomes increased density of the femoral head whihc becomes fragmented and irregular, flattened and sclerosed.
A bone scan can be useful

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14
Q

What is the managment of Perthes’ disease?

A

If detected early and less than half femoral head - rest and traction
If severe, plaster to maintain abduction and possibly osteotomy

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15
Q

What is SUFE?

A

Slipped Upper Femoral Epiphysis
Mainly overweight 10-15 y/o males, especially those underdeveloped sexually
Epiphyseal pate is weak so femoral head slips inferior and posterior
3 types - Acute, Chronic, Acute on Chronic

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16
Q

What is the presentation of a SUFE?

A

Chronic - slowly developing groin/hip/knee pain over several months with a limp, limited movement and slight shortening of effected leg
Acute - Groin pain with a shortened, externally rotated leg. All movements painful
Acute on Chronic

17
Q

What are the investigations for a suspected SUFE?

A

X-ray - Diagnostic

18
Q

What is the management of SUFE?

A

Acute - reduce and pin epiphysis

Chronic - In situ pinning - epiphyseal reduction reduces the risk of AVN

19
Q

What are some of the complications of SUFE?

A

AVN

Chondrolysis - breakdown of articular cartilage (Risk increases with surgery)

20
Q

What is Still’s disease (Juvenile Rheumatoid arthritis)?

A

Usually in 5-10 y/o

Maladaptive immune response triggered by stress or infections

21
Q

How does Still’s disease present?

A 
Fever
Salmon pink rash
Joint pain
Joint swelling
Can be insidious over several months
22
Q

What investigations can be done for suspected Still’s disease?

A

FBC - low Hb, high WCC, high CRP

X-ray

23
Q

What are some of the treatments for Still’s disease?

A

NSAIDs
Corticosteroids
Physiotherapy

24
Q

What is septic arthritis?

A

Infection of a joint causing inflammation and arthritis

25
Q

What organisms commonly cause septic arthritis?

A 
Staphylococcus aureus - 60%
Steptococcus viridans/pneumoniae
Gonococcus
Gram -ive bacilli eg Escherichia coli, Salmonella
*Can be local or haematogenous*
26
Q

What are risk factors for septic arthritis?

A

Previous joint disease
Chronic renal failure
Immunosuppressants
Prosthetic joints

27
Q

What are the symptoms of septic arthritis?

A

Hot swollen joint that is tender to touch
Decreased ROM
Acute
Systemically unwell

28
Q

What investigations can be done for suspected septic arthritis?

A

Joint aspiration for microscopy, increased WCC
Increased CRP, WCC, may have +ive blood cultures
X-ray - joint effusion, cartilage destruction, narrowing of joint space in acute phase with destruction of subchondral bone and sclerosis chronically
Purulent synovial fluid

29
Q

What is the management of septic arthritis?

A

IV Vancomycin & Cefotaxime
Consider joint wash out
Splint joint
Physiotherapy post infection

30
Q

What are some of the complications of septic arthritis?

A

Osteomyelitis
Arthritis
Ankylosis (Stiffness of joint due to adhesion post disease/injury - fusion)

31
Q

Whats the differential for septic arthritis?

A

Crystal arthropathy eg Gout, Pseudogout

Reactive arthritis eg Reiters syndrome

32
Q

What is acute osetomyelitis?

A

Inflammation of bone/bone marrow due to infection

33
Q

What organisms commonly cause osteomyelitis?

A 
Staphylococcus aureus
Steptococcus viridans/pneumoniae
Escherichia coli
Pseudomonas
Salmonella (Especially sickle cell disease)
34
Q

What are some of the risk factors for osteomyelitis?

A

Vascular disease
Trauma
Sickle cell disease (Especially children)
Immunosuppression
Children have a rich blood supply to the growth plate so can effect metaphysis

35
Q

What is the presentation of osteomyelitis?

A 
Pain
Tenderness
Decreased ROM
Increased local temperature
Erythematous
Systemically unwell
May have effusions in neighbouring joints
36
Q

What investigations can be done for osteomyelitis?

A

Increased CRP, WCC, +ive blood cultures (In 60%)
On x-ray - Haziness + ↓ bone density, Sub-periosteal reaction, Involucrum (layer of new bone growth outside existing bone)
MRI can be very sensitive

37
Q

What is the treatment of osteomyelitis?

A

IV Vancomycin & Cefotaxime
Drain abscess and remove sequestra
Analgesia

MSK - Phase II (17 decks)

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