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Year 4 - Paediatrics > Ortho - Hip Pain > Flashcards

Ortho - Hip Pain Flashcards

1
Q

How does hip pain present?

A
  • Limp
  • Refusal to use affected leg
  • Refusal to weight bear
  • Inability to walk
  • Pain
  • Swollen or tender joint
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2
Q

What are some causes of hip pain in different age groups?

A

0-4 years
- Septic arthritis
- Transient sinovitis
- Developmental dysplasia of the hip (DDH)

5-10 years
- Septic arthritis
- Transient sinovitis
- Perthes disease

10-16 years
- Septic arthritis
- Juvenile idiopathic arthritis
- Slipped upper femoral epiphysis (SUFE)

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3
Q

What are the red flags for hip pain?

A
  • Under 3
  • Fever
  • Waking at night with pain
  • Weight loss
  • Anorexia
  • Night sweats
  • Fatigue
  • Persistent pain
  • Stiffness in the morning
  • Swollen or red joint
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4
Q

What is the criteria for urgent referral in a limping child?

A
  • Under 3
  • Older than 9 with restricted or painful hip
  • Can’t weight bear
  • Neurovascular compromise
  • Severe pain or agitation
  • Red flags for serious pathology
  • Abuse suspicion
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5
Q

How is hip pain managed?

A
  • CRP and ESR for JIA and septic arthritis
  • X-rays for fractures and SUFE
  • USS - effusion in joint
  • Joint aspiration - septic arthritis
  • MRI - osteomyelitis
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6
Q

When is septic arthritis most common?

A

Under 4

Can happen at any age

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7
Q

Why is septic arthritis an emergency?

A

Infection can destroy joint and cause systemic illness

10% mortality

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8
Q

What is septic arthritis a common complication of?

A

Joint replacement

1% of hip and knee

Higher in revision surgeries

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9
Q

How does septic arthritis present?

A

Usually single joint
- Rapid onset
- Hot, red, swollen and painful joint
- Refusing to weight bear
- Stiffness and reduced range of motion
- Systemic symptoms e.g. fever, lethargy and sepsis

Subtle in young kids so always consider

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10
Q

What are the common causes of septic arthritis?

A

Staphylococcus aureus most common

  • Neiserria gonorrhoea
  • Group A streptococcus (strep pyo)
  • Haemophilus influenzae
  • Escherichia coli
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11
Q

When is Neisseria gonorrhoea more likely in septic arthritis?

A

Sexually active teenagers

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12
Q

What are some differential diagnoses of septic arthritis?

A

Transient synovitis
Perthes disease
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis

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13
Q

How is septic arthritis managed?

A

Low threshold for treatment until excluded with joint fluid examination

Urgent admission and ortho team involvement

Aspirate joint prior to antibiotics if possible
Send sample for
- Gram staining
- Crystal microscopy
- Culture
- Antibiotic sensitivites

Empiral IV antibiotics until sensitivites known

Surgical drainage and washout of joint

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14
Q

What is the joint fluid like in septic arthritis?

A

Purulent

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15
Q

How long are antibiotics continued for in septic arthritis?

A

3-6 weeks

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16
Q

What causes transient synovitis?

A

Temporary irritation and inflammation in the synovial membrane of the joint

17
Q

What sign can help rule out septic arthritis in transient synovitis?

A

Typically no fever

18
Q

How does transient synovitis present?

A

Occurs within a few weeks of viral illness
- Limp
- Refusal to weight bear
- Groin or hip pain
- Mild low grade temperature

19
Q

How is transient synovitis managed?

A

Symptomatic treatment with simple analgesia

Exclude other pathology

Safety net advice to attend A&E if symptoms worsen or develop a fever

Followed up at 48 hours and 1 week to ensure symptoms are improving

20
Q

When can transient synovitis be managed in primary care?

A

If present for less than 48 hours

21
Q

What is the prognosis of transient synovitis?

A

Significant improvement after 24-48 hours

Resolve fully within 1-2 weeks without lasting problems

Recur in 20% of patients

22
Q

What does perthes disease involve?

A

Disruption to blood flow of the femoral head leading to avascular necrosis

This affects the epiphysis of the femur

23
Q

What age are children affected by Perthes disease?

A

4-12 years

Mainly between 5-8 years
More boys affected than girls

24
Q

What causes perthes disease?

A

No clear cause of trigger

May be due to repetitive mechanical stress to the epiphysis interrupting blood supply

25
Q

What is the main complication of perthes disease?

A

Soft and deformed femoral head leading to early osteoarthritis

Leads to total hip replacement in 5%

This occurs due to revascularisation and healing of the femoral head

26
Q

How does perthes disease present?

A
  • Pain in hip or groin
  • Limp
  • Restricted hip movement
  • Referred pain to knee
  • No history of trauma

If triggered by trauma consider SUFE

27
Q

What investigations should be used for perthes disease?

A

X-ray initial investigation of choice, can be normal

  • Blood tests - typically normal, used to exclude other causes
  • Technetium bone scan
  • MRI scan
28
Q

How is perthes disease managed?

A

Initially conservative

Aim is to maintain a healthy position and alignment in the joint and reduce risk of damage to the femoral head
- Bed rest
- Traction
- Crutches
- Analgesia

Physiotherapy- retain ROM without excess stress on the bone
Regular xrays - to assess healing
Surgery - older children that are not healing

29
Q

What is a slipped upper femoral epiphysis?

A

Head of the femur displaced along the growth plate

30
Q

When is a SUFE more common?

A

Boys aged between 8-15 years

Average age of 12 in boys

Presents slightly early in girls at 11

Obese children

31
Q

How does SUFE present?

A

Obese male during growth spurt

Can be a history of minor trauma that triggers symptoms

Disproportionate pain to severity of the trauma

32
Q

What symptoms does SUFE present with?

A
  • Hip, groin, thigh or knee pain
  • Restricted ROM in hip
  • Painful limp
33
Q

When examining SUFE how do patients prefer to keep their hip?

A

External rotation

Limited ROM particularly restricted internal rotation

34
Q

How is SUFE diagnosed?

A

Xray
Blood tests - exclude other pathology
Technetium bone scan
CT scan
MRI scan

35
Q

How is SUFE managed?

A

Surgery

Needed to return femoral head to correct position and fix it in place to prevent it slipping further

Year 4 - Paediatrics (150 decks)

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