Limping child

Question 1

what are some causes of a limping child ?

Answer 1

DDH 
transient synovitis 
septic arthritis 
perthes 
SUFE
JIA

Question 2

state some risk factors for DDH?

Answer 2

FH
 Breach presentation  Oligohydramnios
female

Question 3

how does DDH present ?

Answer 3

Asymmetric skin folds

 Limp / abnormal gait

Question 4

what is the management of DDH?

Answer 4

maintain abduction

Question 5

what are the two screening tests for DDH ?

Answer 5

ortolani

barlow

Question 6

what is the commonest cause of acute hip pain in children ?

Answer 6

transient synovitis (irritable hip)

Question 7

what is the presentation of transient synovitis ?

Answer 7

2-12yrs
 Sudden onset hip pain / limp
 Often following or with viral infection
 Not systemically unwell
blood tests are normal

Question 8

what is the management of transient synovitis ?

Answer 8

RIPE (rest, ice, pain killers, elevate)

settles over 2-3days

Question 9

what gender is more affected by perthes disease ?

Answer 9

males

Question 10

what would the x rays should in perthes disease ?

Answer 10

normal initially

 ↑ density of femoral head
 Becomes fragmented and irregular
 Flattening and sclerosis

Question 11

if perthes disease is detected early and only half of the femoral head is affected then what is the management ?

Answer 11

bed rest and traction

Question 12

what is the management for severe perthes disease ?

Answer 12

Maintain hip in abduction ̄c plaster

 Femoral or pelvic osteotomy

Question 13

what is the presentation of SUFE?

Answer 13

Groin pain
 Shortened, externally rotated leg 
All movements painful

Question 14

what investigation confirms the diagnosis of SUFE?

Answer 14

Xray

Question 15

what are the complications of SUFE?

Answer 15

Chondrolysis: breakdown of articular cartilage
↑ risk ̄c surgery

AVN

Question 16

what investigations should be done for perthes disease ?

Answer 16

X-rays

bone scan

Question 17

what is the management of SUFE?

Answer 17

Acute: reduce and pin epiphysis

 Chronic: in situ pinning

Question 18

what investigation should be done to rule out other DD for transient synovitis ?

Answer 18

aspiration and culture if able