Limping child

Question 1

Wahat are the different types of abnormal gait?

Answer 1

Antalgic, short leg trendelenburg, stiff knee, spastic

Question 2

What blood tests are needed to assess a limping child?

Answer 2

FBC (wcc would be raised), CRP, ESR raised in infection/inflammation, autoimmune markers or blood cultures

Question 3

What does DDH mean

Answer 3

Developmental dysplasia of the hip

Question 4

When is DDH diagnosed

Answer 4

A few months after birth.

Question 5

What is transient synovitis

Answer 5

Reactive inflammation of synovium often with preceeding viral illness.

Question 6

Who is most usually affected by transient synovitis

Answer 6

boys 3-10 years old

Question 7

What will bloods show in a patient with transient synovitis show

Answer 7

Normal, to mildly increased

Question 8

Describe treatment and how Transient synovitis resolves

Answer 8

Resolves spontaneously, treated with NSAIDs

Question 9

WHat is osteomyesitis

Answer 9

Infection in bone, Hx of trauma, range of movement less effected

Question 10

How is osteomyelitis treated?

Answer 10

Not usually with surgery but antibiotics unless subperiosteal abscess, or large intraosseous collection

Question 11

What is septic arthritis

Answer 11

Infection within the joint space

Question 12

What investigations are essential for septic arthritis

Answer 12

CRP, ESR, WCC< cultures, plain film,

Question 13

How is septic arthritis treated

Answer 13

urgent washout

Question 14

What are the risk factors of DDH

Answer 14

Female, first born, breech, first degree family history, oligohydramnios, packaging disorders

Question 15

What does oligohydramios mean

Answer 15

low levels of amniotic fluid

Question 16

What will a positive barlow test show

Answer 16

The hip is unstable

Question 17

What will a positive ortolani test show

Answer 17

The hip is dislocated

Question 18

What is perthes disease

Answer 18

Idiopathic avascular necrosis of the femoral head

Question 19

Which children are most likely to suffer from perthes

Answer 19

Males, 4-9 years old

Question 20

how does perthes present

Answer 20

Stiff hip, pain, limp, and leg length discrepency

Question 21

What are the four stages of perthes

Answer 21

Initial/sclerotic, fragmentation, healing, and remodelling

Question 22

What is the treatment for Perthes

Answer 22

Physio for ROM, brace/plasters, wheelchair, bisphosphonates

Surgery: Femoral osteotomy, pelvic osteotomy, hip distraction

Question 23

What does SCFE/SUFE stand for?

Answer 23

Slipped capital/upper femoral epiphysis

Question 24

What actually is SCFE?

Answer 24

When the femoral head slips in telation to epiphysis leaving head posterior and inferior

Question 25

Who are more likely to suffer from SCFE

Answer 25

Males more likely at 3:2 ratio. association with obesity, 8-15 year olds

Question 26

What are the symptoms of SCFE?

Answer 26

Activity related pain in hip, could be thigh or knee. Bilateral 25% of the time. Limp is antalgic, externally rotated limb

Question 27

WHat is the differenc ebetween acute and chronic SCFE

Answer 27

Acute is <3/52, and has a higher risk of avascular necrosis

Question 28

What is the difference between stable and unstable SCFE

Answer 28

Stable can weightbear, no avascular necrosis. Unstable cannot weightbear, may have 47% AVN

Question 29

What is the treatment for SCFE

Answer 29

Femoral osteotomy to rehape femur, if severe attempt open reduction and osteotomy though this poses AVN risk