Paed Ortho - Acute Limping Child

Question 1

Commonest Causes of limping kids other than the big 3 [4]

Give 3 less common causes

Answer 1

• Septic Arthritis (1 or 2 a year)
• Osteomyelitis
• Toddler’s Fracture
• Soft Tissue Injury

Less Common:

• NAI (non-accidental injury)
• Tumour
• Endocrinopathies

Question 2

Define SUFE

Answer 2

Femur Epiphysis is displaced, usually posteromedially

Question 3

SUFE
Gender distribution
Onset in males, females
RF [3]

Answer 3

60:40
Males at 13/14 and most girls at 12
Associated with kids who are overweight or have delayed bone age. Endocrinopathies eg hypothyroidism

Question 4

SUFE Presentation other than limp [3]

Leg position [2]

Answer 4

Pain in groin/thigh/knee
Deformity
Trauma (most children have a trauma history)
Leg is often rotated externally and have obligatory external rotation in flexion

Question 5

How do we diagnose SUFE [2] and treat [1]?

Answer 5

X-ray, AP and Frog-Lateral

Pinning-in-situ

Question 6

What history would suggest an infection such as OM, SA or Transient Synovitis? [5]

Answer 6

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

Question 7

Tests for Infection causing limp? [5]

2 imaging options

Answer 7

Take Temp
Blood cultures
WCC, CRp, ESR
Creatine Kinase

US and/or X-ray

Question 8

How do you tell SA apart from the other infections?

Answer 8

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.

Question 9

SUFE complications [5]

Answer 9

AVN
Chondrolysis
Deformity, impingement
Early OA, limb length discrepancy
Possibility of slip on other side

Question 10

What can predispose you to DDH? [4]

Answer 10

Being first born, breech birth
FH
Oligohydramnios
Having another lower limb deformity

Question 11

Does DDH affect one hip more than another? [1]

Answer 11

Yes 3x more likely in the left hip. Something to do with how you pass down the birth canal

Question 12

What signs can be used to screen for DDH on a newborn exam? [3]

Answer 12

Ortolani’s Sign
Barlow’s Sign
Piston Motion Sign

Question 13

How do we confirm DDH? [2]

How do we manage DDH? [1]

Answer 13

Focussed Examination and US
Spica Casts (specific type of plaster cast designed to realign the joint)

Question 14

Perthes disease presentation [5]

Answer 14

Male, primary school age
Short stature
Knee pain on exercise, limp
Stiff hip joint
Systemically well

Question 15

Perthes disease: 4 waldenstrom stages

Answer 15

Initial stage
Fragmentation stage
Re-ossification stage
Healed stage

Question 16

Treatment Perthes Disease [3]

Answer 16

Splints
Physiotherapy
Restrict painful activities eg jumping, NWB
Analgesia
Maintain hip motion

Question 17

Blood supply to neck of femur [3]

Answer 17

Artery of ligament teres
Lateral circumflex artery
Medial circumflex artery