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14. Year 2: Musculoskeletal > Paediatric Orthopaedics - The Limping Child > Flashcards

Paediatric Orthopaedics - The Limping Child Flashcards

1
Q

What is a limp?

A

Limp = abnormal gait commonly due to pain, weakness or deformity

Defined as shorter stance phase on affected limb

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2
Q

What does the clinical presentation of a limp correlate to?

A
  • Pain
    • Antalgic gait
  • Weakness
    • Trendelenberg gait
  • Short limb
    • Toe walk
  • Stiff joint
    • Adducted and loss of rotation
  • Spasticity
  • Poor balance
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3
Q

What does the aetiology of a limp change with?

A

Age group

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4
Q

Why is it important to differentiate the cause of a limp when infection and inflammation are involved?

A

In infection and inflammation important to differentiate the cause as some are more damaging:

  • Septic arthritis
    • Most urgent
  • Osteomyelitis
  • Transient synovitis
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5
Q

What are the clinical features of a limp due to infection and inflammation?

A
  • Limp (age dependent)
  • Pain
  • Systemic features
    • Malaise, loss of appetite, temperature
  • Recent URTI/ear infection
  • Trauma
  • Pseudoparalysis
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6
Q

What is seen in the examination for a limp when infection and inflammation is involved?

A
  • Look sick
  • Limp
  • Able to weight bear
  • Localising area
    • Ankle/tibia/knee/thigh/hip
  • What movements hurt
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7
Q

What investigations are done for a limp when infection and inflammation is involved?

A
  • 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
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8
Q

What is used to differentiate between septic arthritis and osteomyelitis?

A

Kocher criteria

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9
Q

What does Kocher criteria look at?

A

Pyrexia

Weight bearing

WBC count

ESR

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10
Q

What does ESR stand for?

A

Erythrocyte sedimentation rate

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11
Q

What does an ESR blood test monitor?

A

Infection and inflammation rate

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12
Q

What bacteria usually causes septic arthritis in children?

A

Staph. Aureus

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13
Q

What is the presentation of septic arthritis in children?

A
  • Limping
  • Pseudoparalysis
  • Swollen, red joint
  • Refusal to move joint
  • Pain
  • Pyrexia
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14
Q
A
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15
Q

Is septic arthritis more common in lower or upper limbs?

A
  • More common in lower limb than upper
    • Knee most common then hip
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16
Q

What are routes of entry for bacteria into a joint?

A
  • Haematological spread (most common)
  • Dissemination from osteomyelitis
  • Spread from adjacent soft tissue infection
  • Diagnostic or therapeutic measures
  • Penetrating damage by trauma
17
Q

What is the most common route of entry for bacteria into a joint?

A
  • Haematological spread (most common)
18
Q

What is the treatment for septic arthritis?

A
  • Surgery
    • Aspiration
    • Usually carried out arthroscopy, but arthrotomy in hip
  • Antibiotics
    • IV
19
Q

How is the incidence of osteomyelitis changing?

A
  • Incidence is declining
20
Q

What are risk factors for osteomyelitis?

A
  • Blunt trauma
  • Recent infection
21
Q

Describe the pathogenesis of acute haematological osteomyelitis?

A
  • 3 factors
  • Vascular anatomy
    • Vascular loops
    • Terminal branches
  • Cellular anatomy
    • Inhibited phagocytosis
      • Low pO2
  • Trauma
22
Q

What are the clinical features of osteomyelitis?

A
  • Pain
  • Fever
  • Reduced ROM
  • Reduced weight bearing
23
Q

Describe the microbiology of osteomyelitis?

A
  1. Staph aureus
  2. Strep pneumoniae
  3. Staph epidermidis
24
Q

What is the treatment for osteomyelitis?

A
  • Surgery
    • Indications for surgery include
      • Aspiration for culture
      • Drainage of subperiosteal abscess
      • Drainage of septic joint
      • Debridement of dead tissue
      • Failure to improve
  • Antibiotics
25
Q

What are indications for surgery in osteomyelitis?

A
  • Aspiration for culture
  • Drainage of subperiosteal abscess
  • Drainage of septic joint
  • Debridement of dead tissue
  • Failure to improve
26
Q

How is transient synovitis diagnosed?

A

Diagnosis of exclusion

27
Q

What is the presentation of transient synovitis?

A
  • Limping
  • Slightly unwell
  • History of viral infection
  • Apyrexial
  • Not that unwell
28
Q

What does JIA stand for?

A

Juvenile idiopathic arthritis

29
Q

What are the 3 groups of JIA?

A
  • Pauciarticular
    • Early onset pauciaritular JIA (EOPA)
    • Late onset pauciarticular JIA (LOPA)
  • Polyarticular
    • Seronegative
    • Seropositive
  • Systemic onset
30
Q

What are some features that raise concern of neoplasm?

A
  • Night pain
  • Stops doing sport/going out
  • Sweats and fatigue
  • Abnormal blood results
    • Low Hb atypical blood film, atypical platelets
31
Q

What is a neoplasm?

A

A new and abnormal growth of tissue in a part of the body, especially as a characteristic of cancer

14. Year 2: Musculoskeletal (40 decks)

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