Limping child Flashcards
Wahat are the different types of abnormal gait?
Antalgic, short leg trendelenburg, stiff knee, spastic
What blood tests are needed to assess a limping child?
FBC (wcc would be raised), CRP, ESR raised in infection/inflammation, autoimmune markers or blood cultures
What does DDH mean
Developmental dysplasia of the hip
When is DDH diagnosed
A few months after birth.
What is transient synovitis
Reactive inflammation of synovium often with preceeding viral illness.
Who is most usually affected by transient synovitis
boys 3-10 years old
What will bloods show in a patient with transient synovitis show
Normal, to mildly increased
Describe treatment and how Transient synovitis resolves
Resolves spontaneously, treated with NSAIDs
WHat is osteomyesitis
Infection in bone, Hx of trauma, range of movement less effected
How is osteomyelitis treated?
Not usually with surgery but antibiotics unless subperiosteal abscess, or large intraosseous collection
What is septic arthritis
Infection within the joint space
What investigations are essential for septic arthritis
CRP, ESR, WCC< cultures, plain film,
How is septic arthritis treated
urgent washout
What are the risk factors of DDH
Female, first born, breech, first degree family history, oligohydramnios, packaging disorders
What does oligohydramios mean
low levels of amniotic fluid
What will a positive barlow test show
The hip is unstable
What will a positive ortolani test show
The hip is dislocated
What is perthes disease
Idiopathic avascular necrosis of the femoral head
Which children are most likely to suffer from perthes
Males, 4-9 years old
how does perthes present
Stiff hip, pain, limp, and leg length discrepency
What are the four stages of perthes
Initial/sclerotic, fragmentation, healing, and remodelling
What is the treatment for Perthes
Physio for ROM, brace/plasters, wheelchair, bisphosphonates
Surgery: Femoral osteotomy, pelvic osteotomy, hip distraction
What does SCFE/SUFE stand for?
Slipped capital/upper femoral epiphysis
What actually is SCFE?
When the femoral head slips in telation to epiphysis leaving head posterior and inferior
Who are more likely to suffer from SCFE
Males more likely at 3:2 ratio. association with obesity, 8-15 year olds
What are the symptoms of SCFE?
Activity related pain in hip, could be thigh or knee. Bilateral 25% of the time. Limp is antalgic, externally rotated limb
WHat is the differenc ebetween acute and chronic SCFE
Acute is <3/52, and has a higher risk of avascular necrosis
What is the difference between stable and unstable SCFE
Stable can weightbear, no avascular necrosis. Unstable cannot weightbear, may have 47% AVN
What is the treatment for SCFE
Femoral osteotomy to rehape femur, if severe attempt open reduction and osteotomy though this poses AVN risk
