limping child and septic arthritis Flashcards
1
Q
what are possible causes of leg pain in the limping child?
A
- growing pains
- transient synovitis
- septic arthritis
- trauma
- osteomyelitis
- Perthes disease
- Slipped capital femoral epiphyses
- neoplastic disease
2
Q
what types of tumours tend to cause leg pain? and what ages?
A
- neuroblastoma (0-5)
- Ewings sarcoma (5-15)
- osteosarcoma (5-15)
3
Q
what infective causes are there for the limping child?
A
- septic arthritis
- TB & Malaria
- Lyme disease
- viral
4
Q
what age group is septic arthritis most common in?
what are the red flags?
A
- those <2 years
- fever
- refusal to use joint
- elevated ESR and CRP
5
Q
how does septic arthritis mostly occur?
what joints are mostly affected?
A
- haematogenous spread
- from a puncture wound or infected skin lesion
- hip, knee and ankle joints
6
Q
what are the causative organisms for this?
A
- most commonly staph aureus
- (used to be h.influenza before immunisation)
- NOTE: consider sickle cell disease if joint painful
7
Q
how might the septic arthritis patient present?
A
- initial presentation: limping
- erythematous, warm and tender joint
- reduced ROM
- febrile
- joint effusion
- in neonates limb is immobile
8
Q
what might make you think it is osteomyelitis?
what investigations would you do for septic arthritis?
A
- specific bony tenderness
- ESR and CRP, WCC
- blood cultures
- ultrasound the joint
- aspiration of joint space (Gold standard)
9
Q
what is the treatment of septic arthritis?
A
- IV flucloxacillin and Abx continued for 4-6 weeks
- vancomycin for MRSA
- surgical drainage of joint
- joint splinting
- physio to restore function
