Paediatric Orthopaedics - The Limping Child Flashcards
What is a limp?
Limp = abnormal gait commonly due to pain, weakness or deformity
Defined as shorter stance phase on affected limb
What does the clinical presentation of a limp correlate to?
- Pain
- Antalgic gait
- Weakness
- Trendelenberg gait
- Short limb
- Toe walk
- Stiff joint
- Adducted and loss of rotation
- Spasticity
- Poor balance
What does the aetiology of a limp change with?
Age group
Why is it important to differentiate the cause of a limp when infection and inflammation are involved?
In infection and inflammation important to differentiate the cause as some are more damaging:
- Septic arthritis
- Most urgent
- Osteomyelitis
- Transient synovitis
What are the clinical features of a limp due to infection and inflammation?
- Limp (age dependent)
- Pain
- Systemic features
- Malaise, loss of appetite, temperature
- Recent URTI/ear infection
- Trauma
- Pseudoparalysis
What is seen in the examination for a limp when infection and inflammation is involved?
- Look sick
- Limp
- Able to weight bear
- Localising area
- Ankle/tibia/knee/thigh/hip
- What movements hurt
What investigations are done for a limp when infection and inflammation is involved?
- Bloods
- WCC, CPR, ESR, CK, cultures
- X-ray
- Document state of bone other than see infection as takes 3 weeks to see
- USS
- Confirm effusion of joint which might not be obvious clinically
What is used to differentiate between septic arthritis and osteomyelitis?
Kocher criteria
What does Kocher criteria look at?
Pyrexia
Weight bearing
WBC count
ESR
What does ESR stand for?
Erythrocyte sedimentation rate
What does an ESR blood test monitor?
Infection and inflammation rate
What bacteria usually causes septic arthritis in children?
Staph. Aureus
What is the presentation of septic arthritis in children?
- Limping
- Pseudoparalysis
- Swollen, red joint
- Refusal to move joint
- Pain
- Pyrexia
Is septic arthritis more common in lower or upper limbs?
- More common in lower limb than upper
- Knee most common then hip
What are routes of entry for bacteria into a joint?
- Haematological spread (most common)
- Dissemination from osteomyelitis
- Spread from adjacent soft tissue infection
- Diagnostic or therapeutic measures
- Penetrating damage by trauma
What is the most common route of entry for bacteria into a joint?
- Haematological spread (most common)
What is the treatment for septic arthritis?
- Surgery
- Aspiration
- Usually carried out arthroscopy, but arthrotomy in hip
- Antibiotics
- IV
How is the incidence of osteomyelitis changing?
- Incidence is declining
What are risk factors for osteomyelitis?
- Blunt trauma
- Recent infection
Describe the pathogenesis of acute haematological osteomyelitis?
- 3 factors
- Vascular anatomy
- Vascular loops
- Terminal branches
- Cellular anatomy
- Inhibited phagocytosis
- Low pO2
- Inhibited phagocytosis
- Trauma
What are the clinical features of osteomyelitis?
- Pain
- Fever
- Reduced ROM
- Reduced weight bearing
Describe the microbiology of osteomyelitis?
- Staph aureus
- Strep pneumoniae
- Staph epidermidis
What is the treatment for osteomyelitis?
- Surgery
- Indications for surgery include
- Aspiration for culture
- Drainage of subperiosteal abscess
- Drainage of septic joint
- Debridement of dead tissue
- Failure to improve
- Indications for surgery include
- Antibiotics
What are indications for surgery in osteomyelitis?
- Aspiration for culture
- Drainage of subperiosteal abscess
- Drainage of septic joint
- Debridement of dead tissue
- Failure to improve
How is transient synovitis diagnosed?
Diagnosis of exclusion
What is the presentation of transient synovitis?
- Limping
- Slightly unwell
- History of viral infection
- Apyrexial
- Not that unwell
What does JIA stand for?
Juvenile idiopathic arthritis
What are the 3 groups of JIA?
- Pauciarticular
- Early onset pauciaritular JIA (EOPA)
- Late onset pauciarticular JIA (LOPA)
- Polyarticular
- Seronegative
- Seropositive
- Systemic onset
What are some features that raise concern of neoplasm?
- Night pain
- Stops doing sport/going out
- Sweats and fatigue
- Abnormal blood results
- Low Hb atypical blood film, atypical platelets
What is a neoplasm?
A new and abnormal growth of tissue in a part of the body, especially as a characteristic of cancer
