The acute liming child Flashcards
What is a limp and how does it present?
Abnormal gait commonly due to pain, weakness or deformity
Common presentation with many causes, define as shorter stance, phase, weight bearing on the affected limb. It is often not always due to pain
What are the common cause of limps in young childre>
Toxic synovitis (very common) Septic athritis Trauma Osteomyeltis Viral syndrome Perthes Fracture
What regions mainly cause limp?
Hip and lower leg
What are important questions to deal with when discussing the limp?
Duration and progression of limp Recent trauma and mechanism Associated pain and characteristics Accompanying weakness Can the child bear weight does the limp limit daily activities Fever, weight loss?
What important things are looked for on history of an acute limping child?
Sole of foot for foreign bodies Deformity, eryhtmea, swellinf, effusiom ROM Assess shoes Scoliosis/ other spinal pathologies Gair barefoot Leg length
What else is done during the examination of an acute limping child?
Feel and move
Neurological assessment
What big three diseases causes an acute limping child?
Transient synovitis
Ostomyelitis
Septic arthritis
How does the acute limping child with the big three present?
Do they look sick? Limp? Absolute refusal to weighht bear? Localised area Hip, external rotation? What movemtns hurt
What are your differentials if you suspect transient synovitis, osteomyelitis septic arthritis
Sarcoma Myositis osteoid osteoma Abscess Inflammatory arthropathy
What initial investigations are carried out if transient synovitis, osteomyeltits and septic arthritis are suspected
temperature
x-ray
USS
WBC, CRP,ER,CK, cultures
How does septic arthritis present
Limp Pseudoparalysis Swollen,red joint Refusal to move joint Pain Fever more common in knee and hip
What does investigations show in septic arthritis?
FBC and differential- Raised WCC ESR>50mm/h Blood cultures postive in 35% Xray, always be present for ultrasound Synovial fluid WCC> 50,000
How do you treat septic arthritis?
Typically staph aureus Antibiiotics- two weeks impirically, 6 weeks total Aspiration Arthroscopy Arthrotomy
How does osteomyelitis present?
Around 6 years old Blunt truama, recent infection Caused by vascular anatomy, cellular anatomy, inhibited phagocytosis Pain, localised symptoms Fever reduced range of movement reduced weight bearing
What biochemical markers may be present?
WCC>35
ESR>90
CRP>80
