locomotive Flashcards
what is septic arthritis
it is an infection of the synovial joint by blood infection seeding to the joint
what is the most common age of septic arthritis
50% presenting < 2 yrs old
M:F 2:1
what are the commonly affected joint?
knee> hip > ankle
common pathogens causing septic arthritis in < 12 months old
staph aureus
group B strep
candida albcians
common pathogens causing septic arthritis in 1-5 yrs old
staph aureus
Haemophilus influenza (if not immunised)
group A strep
strep pneumoniae
common pathogens causing septic arthritis in 1-5 yrs old and if sexually abuse
N. gonorrhoea
common pathogens causing septic arthritis in 5-12 yrs old
staph aureus
group a strep
common pathogens causing septic arthritis in 12 - 18 yrs old
staph aureus
N. gonorrhoea (if sexually active)
symptoms of septic arthritis
red, hot, swollen joints fever (only in 50% of ppl) restricted range of movement of affected joints inability to weight bear psuedo-paralysis systemic infection signs
what is psudeo-paralysis
voluntary restriction of movement due to pain, incoordination etc
investigations for septic arthritis
FBC - raised WCC
raised CRP
x-ray of the joint - might show widening of joint space - effusion (subluxation/dislocation, joint space narrowing nad erosion changes are late signs
USS guided aspiration - for MC+S - purulent
blood culture before abx
LP - if Haemophilus influenza inc risk of meningitis
what serious infection can septic arthritis
haemophilus influenza - meningitis
management of septic arthritis
IV flucloxacillin + ceftriaxone
vancomycin if penicillin allergy
mini-arthrotomy - washout of the joint
splint joint - to reduce pain
physiology - to avoid joint stiffness
prognosis of septic arthritis
if early intervention - good outcome
if treated late, can lead to joint destruction
what is slipped femoral epiphysis
it is when the proximal femur epiphysis displaced due to the weakness of growth plate
aetiology of slipped femur epiphysis
unknown - can be due to endocrine function
RF for slipped femoral epiphysis
Obese children (> 95th centile)
african american
FX
puberty (accelerated growth )
clinical features of the slipped femoral epiphysis
pain in groin, thigh and knee
antalgic gait
abduction + external rotation and limted internal rotation of the hip
limb shorted
thigh atrophy
Ix for slipped femur epiphysis
X-ray to investigation and diagnosis
MRI can help
TFT - theortical associated link
mx of slipped femour epiphysis
surgical - pin in situ allow growth
What is perthe’s disease
It is avascular necrosis of femoral head
Secondary to repeated micro-trauma or follow episodes of transient synovitis and recurrent episodes of hip irritability
What is the common age group for perthe’s disease
2-12 ys - adverb 7
M>F
Clinical features of Perthe’s disease
Initially painless —> crush fracture develops —> pain in the hip/knee + limp
Ix/diagnosis of perthe’s disease
Diagnosed by X-RAY/bone scan
Management of Perthe’s disease
Symptomatic - rest, analgesia, observation if < 6 yrs old
Bracing or traction - recovery may take 2-3 years
Surgery for olde chiller if severe involvement
Prognosis of Perthe’s disease
Risk of later degenerative arthritis
Worse prognosis if > 10 yrs old
Extensive femoral head deformity
Very good prognosis in children < 5 yrs old
