Paediatric Orthopaedics - Limp

Question 1

What is Perthe’s Disease?

Answer 1

Avascular necrosis of epiphysis of femoral head

-due to compromised blood supply

Question 2

How does Perthe’s Disease present?

Answer 2

Insidious onset
Limp
Hip/knee pain

Question 3

What investigations are appropriate in suspected Perthe’s Disease?

Answer 3

X-ray (density in femoral head, bilat in 10-20%)
Bone scan
MRI

Question 4

What are the management options for Perthe’s Disease?

Answer 4

Rest
Physiotherapy
Traction, plaster casts
Surgery

Question 5

What is the prognosis of Perthe’s Disease?

Answer 5

Good
-esp if <6yrs & <50% epiphysis involved
In older children
-deformity of fem head/metaphyseal damage
-inc likelihood of degen arthritis in adult life

Question 6

What is Slipped Capital Femoral Epiphysis?

Answer 6

Postero-inferior displacement of epiphysis

-can cause avascular necrosis

Question 7

How does SCFE present?

Answer 7

Bilat in 20%
Acute (post minor trauma)
Limp
Hip/knee pain
Restricted abduction/internal rotation

Question 8

What are the risk factors for SCFE?

Answer 8

Male
Obese
10-15yrs
Hypothyroidism
Hypogonadism

Question 9

What investigations are appropriate in suspected SCFE?

Answer 9

X-ray (frog lateral view)

Question 10

How is SCFE managed?

Answer 10

Surgical fixation

Question 11

What is Transient Synovitis?

Answer 11

Viral infection causing acute hip pain

-typically 2-12yrs

Question 12

How does Transient Synovitis present?

Answer 12

Sudden onset hip pain/limp
Decreased range of movement
Afebrile (appears well)

Question 13

What investigations are appropriate in suspected Transient Synovitis?

Answer 13

Joint aspiration

Blood cultures

Question 14

How is Transient Synovitis managed?

Answer 14

Bed rest

Skin traction