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Yr3 MSK > Paed Ortho - Acute Limping Child > Flashcards

Paed Ortho - Acute Limping Child Flashcards

1
Q

Commonest Causes of limping kids?

A
  • Septic Arthritis (1 or 2 a year)
  • Osteomyelitis
  • Perthes
  • SUFE (slipped upper femoral epiphysis)
  • Toddler’s Fracture
  • Soft Tissue Injury

Less Common:

  • NAI (non-accidental injury(
  • Tumour
  • Endocrinopathies
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2
Q

Define SUFE?

A

Femur Epiphysis is displaced, usually posteromedially

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3
Q

When do kids get SUFE?

A

60:40 more often in males
ranges from 9-16yrs with most males at 13/14 and most girls at 12

Associated with kids who are overweight or have delayed bone age.

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4
Q

What causes SUFE?

A

Associated with growth spurts of adolescense who are overweight or have delayed bone age.

Also caused by certain endocrinopathies like hypothyroidism.

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5
Q

how does SUFE present?

A

Pain in groin/thigh/knee
Limp
Trauma (most children have a trauma history)
Deformity

ROM may be limited by pain.
Leg is often rotated externally and have obligatory external rotation in flexion

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6
Q

How do we diagnose SUFE and treat?

A

X-ray, AP and Frog-Lateral, may be very subtle but can see the displaces head on top of the epiphysis

Pinning-in-situ

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7
Q

What history would suggest an infection such as OM, SA or Transient Synovitis?

A
  • Limp
  • Pain
  • Generally unwell (malaise, appetite loss or listless)
  • Temperature
  • Recent infection e.g. URTI or ear infection.
  • Trauma (most kids have one)
  • Pseudoparalysis (usually too much pain to move or WB)
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8
Q

Tests for Infection causing limp?

A 
Blood cultures
WCC
CRP
ESR
Creatine Kinase

US and/or X-ray

Take Temp

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9
Q

How do you tell SA apart from the other infections?

A

SA will be so painful they may have pseudoparalysis and not be able to walk/WB at all.
Joint will be visibly swollen and red.

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10
Q

How does SA arise in kids?

A

Mostly haematogenous from another infection

Rarely its from a penetrating injury, injection into joint or spread from osteomyelitis

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11
Q

How do we test for SA specifically?

A 
FBC & Differential WCC
ESR & CRP
Blood cultures
X-ray
US!!
Synovial fluid aspiration - WCC, gram stain & culture
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12
Q

How do we treat SA?

A

IV abx

Aspiration

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13
Q

How does OM present specifically?

A 
Pain
~ROM reduced
~weight bearing reduced
~fever
~localised signs/symptoms
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14
Q

Testing for OM?

A

WCC
ESR & CRP
X-ray –> MRI/CT/Biopsy/Bone scan
Blood cultures

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15
Q

How do we treat OM?

A

IV Abx
Surgery if:
- aspirating for culture
- Draining abscess

  • Debriding dead shit
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16
Q

What transient condition can cause a limp

A

Transient synovitis

17
Q

What would suggest transient synovitis

A 
Limp
Not that unwell
H/o viral inf e.g. URTI/ear
Apyrexial
Low CRP & normal WCC

Yr3 MSK (38 decks)

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