Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal > The Acute Limping Child > Flashcards

The Acute Limping Child Flashcards

1
Q

What are the common causes of acute limping child?

A
  • Septic arthritis
  • Osteomyelitis
  • Perthes
  • SUFE
  • Toddlers fracture
  • Soft tissue injury

Less common are:

  • NAI
  • Tumour
  • Endocrinopathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does SUFE stand for?

A

Slipped upper / capital femoral epiphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definition of SUFE?

A

Posteromedial displacement of the proximal femoral epiphysis in relation to the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where in the physis does the SUFE occur in the physis?

A

–Through the (widened) zone of hypertrophy in the physis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the epidaemiology of the disease?

A

Males mean is 13/5 years

Females is 12 years

Males 60%

Females 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of SUFE?

A

Increased load, weak physis or both

–Idiopathic

  • Adolescence
  • Delayed bone age
  • Increased weight

–Secondary to underlying disorder (GH-IGF axis)

  • hypothyroidism
  • hypogonadism
  • renal osteodystrophy
  • growth hormone therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the findings on physical examination of SUFE?

A

External rotation of extremity

ROM limited by pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the findings of SUFE on radiology?

A
  • Trethowan’s / Klein’s line - line parallel to the upper edge of the femoral neck
  • More obvious on lateral view
  • Widened physis
  • Horizontal physis (flexion contracture)
  • Knee x-rays are usually normal!
  • Blanch sign of Steel - this is when there is a crescentic shaped area of increased density overlying the metaphysis adjacent to the physis - Increased density is caused by overlapping of the femoral neck and the posteriorly displaced capital epiphysis

Or just an obvious slip

(Klein’s line and the physis is widened and horizontal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What type of X-ray is necessary for SUFE?

A

Frog lateral X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SUFE summary

A
  • Older child (rare but occasionally <10 yrs)
  • Hip / thigh/ knee pain
  • Acute, acute on chronic
  • No clinical indicators of infection
  • Limp, external rotation gait, knee flex into ER
  • Frog lateral x-ray
  • If x-ray positive should be referred for urgent review
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the infections that can cause a limp in a child?

A

Septic arthritis

Osteomyelitis

Transient synovitis

Muscle abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What presenting history might suggest infection?

A
  • Limp (age dependent)
  • Pain
  • General malaise/ loss of appetite/ listless
  • Temperature
  • Recent URTI/ ear infections
  • Trauma
  • Pseudoparalysis
  • Listen to the parent, they are usually right

On examination the child may look sick, limp, refusal to weight bear, localising area, movements that hurt more than others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the initial investigations for a limping child?

A

WCC

CRP ESR

CK

Cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What tests can you use CK for?

A

Heart attack

Rhabdomyolysis

Acute kidney injury

17
Q

What is the presenation for septic arthritis?

A
  • Limping
  • Pseudoparalysis
  • Swollen, red joint
  • Refusal to move joint
  • Pain
  • Temperature
18
Q

What are the most common places for septic arthritis?

A

Most commonly in the hip and the knee

19
Q

What are the routes by which bacteria can enter the joint?

A

Haematogenous route

Dissemination from osteomyelitis

Spread from adjacent soft tissue infection

Diagostic or therapeutic measures

Penetrating damage by punture or trauma

20
Q

What is the investigation for septic arthritis?

A

•FBC & differential

–Raised WCC >12,000/mm3

  • ESR >50mm/hr
  • CRP
  • Blood cultures

– +ve in 30-50%

  • Xray
  • ULTRASOUND- ALWAYS BE PRESENT
  • Synovial fluid

–WCC >50,000/mm3

–Gram stain

–Culture

21
Q

What organism is typically responsible for septic arthritis?

A

Staph aureus

22
Q

What is the treatment for septic arthritis?

A
  • Typically staph aureus infection
  • Aspiration
  • Arthroscopy

–Knee/shoulder/ankle

  • Arthrotomy
  • ANTIBIOTICS
23
Q

What is the mean age for osteomyelitis?

A

6 years

24
Q

What are the risk factors for osteomyelitis?

A

Blunt trauma

Recent infection

25
Q

What are the most common places for osteomyelitis?

A

Femur

Tibia

26
Q

What are the presenting features of osteomyelitis?

A

Pain

Localised signs/symptoms

Fever

Reduced range of movement

Reduced weight bearing

27
Q

What are the blood investigations for osteomyelitis?

A

WCC

ESR

CRP

Blood culture

28
Q

What are the imaging modalities for osteomyelitis?

A

Radiography (poor sensitivity)

Tc99 bone scan

MRi

CT

Ultrasoound scan

29
Q

What is the most likely causative organism for osteomyelitis?

A

Staph aureus

30
Q

What are indications for surgery in osteomyelitis?

A
  • Aspiration for culture
  • Drainage of subperiosteal abscess
  • Drainage of joint sepsis
  • Debridement of dead tissue
  • Biopsy in equivocal cases
31
Q

What is the clinical presentation of transient synovitis?

A
  • Limping, often touch weight bearing
  • Slightly unwell
  • History of viral infection eg URTI/ ear
  • Apyrexial
  • Allowing joint to be examined
32
Q

What are the blood values of CRP and WCC for transient synovitis?

A

Low CRP

Normal WCC

33
Q
A

Musculoskeletal (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions