Paeds limb pain Flashcards

1
Q

What is osteomyelitis

A

Infection of the metaphysis of long bones, commonly distal femur, proximal tibia, spread via haematogenous spread or local skin infection

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2
Q

Common pathogens

A

Staph aureus
Strep A/B
H influenza
Kingella kingae

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3
Q

Sickle cell anaemia is associated with an increased risk of which pathogens in osteomyelitis?

A

Salmonella and staph osteomyelitis

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4
Q

Septic arthritis vs osteomyelitis

A

Septic arthritis - more accute
Osteomyelitis - over a few days

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5
Q

What might you see on x ray?

A

Brodie abscess causing ‘moth sign’

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6
Q

Mx of osteomyelitis

A

IV fluclox and penicillin/fusidic acid
Analgesia
If necessary, surgical debridement / drainiage

If chronic osteomyelitis (more than 2 weeks), treat with surgical debridement and then IV antibiotics

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7
Q

Prognosis of osteomyelitis

A

Can lead to fractures
Septic arthritis
more than 95 percent complete resolution

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8
Q

What is septic arthritis

A

Infection of the SYNOVIUM and JOINT SPACE

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9
Q

Why is septic arthritis so bad

A

Can lead to bone destruction

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10
Q

Age when septic arthritis is most common

A

Under 2 years

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11
Q

Would you do an x ray or USS?

A

Xrays are likely to be normal
do USS for deep joints to reveal effusion
And joint aspiration guided by USS

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12
Q

Transient synovitis vs septic arthritis

A

Kocher’s criteria for septic arthritis:

temp over 38.5
Raised inflammatory markers
WCC over 12
Refusal to weight bear

At rest, kids with transient synovitis look well, and pain is only really on movement, whereas in septic arthritis they look really unwell and have severe pain at rest

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13
Q

Mx of septic arthritis

A

ABCDE approach
Blood cultures
Joint aspiration
IV fluclox for 2 weeks, followed by 4 weeks of PO antibiotics

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14
Q

Septic arthritis prognosis

A

Can be okay if treated early
Delayed or suboptimal treatment can result in growth abnormalities or early osteoarthritis

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15
Q

What causes transient synovitis

A

Reactive synovitis and sterile effusion after an upper respiratory tract infection e.g. viral infection

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16
Q

Management of transient synovitis

A

Bed rest
Pain relief
Usually resolves in a few days

17
Q

Prognosis of transient synovitis

A

Usually resolves in 1 week
Can develop Perthes disease
If it hasn’t resolved in 1 week - refer for urgent specialist assessment

18
Q

What is Perthes disease?

A

Disruption of the blood supply to the bone, causing a change in shape and pain

aka avascular necrosis of the head

19
Q

Which age group and sex does Perthes disease affect more?

A

Boys aged 4-9
Uncommon condition

20
Q

Management of Perthes disease

A

Bed rest + splint (refer to paeds ortho team)
Analgesia
Physio to keep muscles strong

F/U every 3 months for x ray and sometimes arthrogram

21
Q

Prognosis of Perthes disease

A

60 percent resolve spontaneously
Some develop chronic pain, hip stiffness and arthritis

22
Q

Osgood Schlatter management

A

Pain relief
Rest and reduced sports
Physio
Ice pack for 15 mins, 3 times a day and after exercise

23
Q

Osgood schlatter cause

A

Repetitive injury to the tibia causing osteochondritis

24
Q

Osgood schlatter differentials

A

Chondromalacia patellae
Osteochondritis dissecans

25
Q

What is chondromalacia patellae

A

Degeneration of articular cartilage causing anterior knee pain

26
Q

Symptoms of chondromalacia patellae

A

Creptius on extension
Painless when passive but pain when extending/using

27
Q

Management for chondromalacia patellae

A

Physio to strengthen quads

28
Q

Osteochondritis dissecans symptoms

A

Pain AFTER exercise
Locking, giving way

29
Q

Cause of osteochondritis dissecans

A

AVN of articular cartilage and subchondral bone, causing free movements of the particles and causing activity related pain

30
Q

Anterior knee pain during exercise with crepitus

A

Chondromalacia patellae

31
Q

Pain after exercise with locking or giving way

A

Osteochondritis dissecans

32
Q

Anterior knee pain after exercise with swelling over tibial tuberosity

A

Osgood schlatter