Paeds limb pain Flashcards
What is osteomyelitis
Infection of the metaphysis of long bones, commonly distal femur, proximal tibia, spread via haematogenous spread or local skin infection
Common pathogens
Staph aureus
Strep A/B
H influenza
Kingella kingae
Sickle cell anaemia is associated with an increased risk of which pathogens in osteomyelitis?
Salmonella and staph osteomyelitis
Septic arthritis vs osteomyelitis
Septic arthritis - more accute
Osteomyelitis - over a few days
What might you see on x ray?
Brodie abscess causing ‘moth sign’
Mx of osteomyelitis
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
Prognosis of osteomyelitis
Can lead to fractures
Septic arthritis
more than 95 percent complete resolution
What is septic arthritis
Infection of the SYNOVIUM and JOINT SPACE
Why is septic arthritis so bad
Can lead to bone destruction
Age when septic arthritis is most common
Under 2 years
Would you do an x ray or USS?
Xrays are likely to be normal
do USS for deep joints to reveal effusion
And joint aspiration guided by USS
Transient synovitis vs septic arthritis
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
Mx of septic arthritis
ABCDE approach
Blood cultures
Joint aspiration
IV fluclox for 2 weeks, followed by 4 weeks of PO antibiotics
Septic arthritis prognosis
Can be okay if treated early
Delayed or suboptimal treatment can result in growth abnormalities or early osteoarthritis
What causes transient synovitis
Reactive synovitis and sterile effusion after an upper respiratory tract infection e.g. viral infection
Management of transient synovitis
Bed rest
Pain relief
Usually resolves in a few days
Prognosis of transient synovitis
Usually resolves in 1 week
Can develop Perthes disease
If it hasn’t resolved in 1 week - refer for urgent specialist assessment
What is Perthes disease?
Disruption of the blood supply to the bone, causing a change in shape and pain
aka avascular necrosis of the head
Which age group and sex does Perthes disease affect more?
Boys aged 4-9
Uncommon condition
Management of Perthes disease
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
Prognosis of Perthes disease
60 percent resolve spontaneously
Some develop chronic pain, hip stiffness and arthritis
Osgood Schlatter management
Pain relief
Rest and reduced sports
Physio
Ice pack for 15 mins, 3 times a day and after exercise
Osgood schlatter cause
Repetitive injury to the tibia causing osteochondritis
Osgood schlatter differentials
Chondromalacia patellae
Osteochondritis dissecans
What is chondromalacia patellae
Degeneration of articular cartilage causing anterior knee pain
Symptoms of chondromalacia patellae
Creptius on extension
Painless when passive but pain when extending/using
Management for chondromalacia patellae
Physio to strengthen quads
Osteochondritis dissecans symptoms
Pain AFTER exercise
Locking, giving way
Cause of osteochondritis dissecans
AVN of articular cartilage and subchondral bone, causing free movements of the particles and causing activity related pain
Anterior knee pain during exercise with crepitus
Chondromalacia patellae
Pain after exercise with locking or giving way
Osteochondritis dissecans
Anterior knee pain after exercise with swelling over tibial tuberosity
Osgood schlatter
