Paediatric Orthopaedics: The Limping Child

Question 1

Define a limp

Answer 1

A limp is an abnormal gait commonly due to pain, weakness or deformity.
Can be defined as a shorter stance phase on the affected limb

Question 2

Common causes of a limp in children 0-5

Answer 2

Trauma, 
Transient synovitis, 
Osteomyelitis,
Septic arthritis, 
Developmental dysplasia of the hip,
Juvenile idiopathic arthritis

Question 3

Common cause of a limp in 5-10 years old?

Answer 3

Trauma, 
Transient synovitis, 
Osteomyelitis,
Septic arthritis,
Perthes disease

Question 4

Common cause of limp in 10-15 years old?

Answer 4

Trauma,
Osteomyelitis, 
Septic arthritis, 
Chondromalacia, 
Neoplasm, 
Slipped capital femoral epiphysis

Question 5

Define an antalgic gait

Answer 5

A gait with shortened stance phase and has tenderness and reduced ROM

Question 6

Common example causes of antalgic gait

Answer 6

Trauma, 
Toddlers fracture,
Overuse syndrome,
Infection, 
Inflammation

Question 7

Define abductor lurch gait

Answer 7

Abductor lurch with trendelenburg sign

Question 8

Common example causes of abductor lurch gait

Answer 8

Hip dysplasia,

Cerebral palsy

Question 9

Define equines gait

Answer 9

Toe-heel gait

Commonly caused by cerebral palsy

Question 10

Define circumduction gait

Answer 10

Circumduction during swing phase

Question 11

What is pseudoparalysis?

Answer 11

Voluntary restriction or inhibition of motion

Question 12

Septic arthritis presentation

Answer 12

Limping, 
Pseudoparalysis,
Swollen, red joint, 
Refusal to move joint, 
Pain,
Temperature

Question 13

Investigation of septic arthritis

Answer 13

FBC (raised WCC >12,000/mm3),
ESR  (>50mm/hr),
CRP, 
Blood cultures,
Xray,
Ultrasound, 
Synovial fluid-WCC (>50,000/mm3), gram stain, culture

Question 14

4 Kocher Criteria for septic arthritis

Answer 14

Pyrexia (>38deg),
Not weight bearing,
WBC count (>12,000/ml),
ESR (>40mm/hr)

Question 15

Treatment of septic arthritis (4As)

Answer 15

Aspiration,
Arthroscopy,
Arthrotomy,
Antibiotics

Question 16

3 factors causing acute haematogenous osteomyelitis

Answer 16

Vascular anatomy,
Cellular anatomy (inhibited phagocytosis),
Trauma

Question 17

Presenting features of osteomyelitis?

Answer 17

Pain, 
Localised symptoms, 
Fever,
Reduced ROM, 
Reduced weight bearing

Question 18

Investigations for osteomyelitis

Answer 18

ESR,
CRP,
Ultrasound, 
Bone scan, 
CT, 
Bone biopsy

Question 19

Presentation of transient synovitis

Answer 19

Limping, 
Often touch weight bearing,
Slight malaise, 
History of viral infection,
Apyrexial,
Low CRP but normal WCC,
Normally allow joint to be examined and don’t seem that unwell

Question 20

Red flags of a limping child that would suggest neoplasm

Answer 20

Night pain,
Incidental trauma,
Stops doing sport/ going out, 
Sweats ad fatigue, 
Abnormal blood results