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Systems: MSK AB > The Acute Limping Child > Flashcards

The Acute Limping Child Flashcards

1
Q

What are common causes of limp?

A
  • Septic arthritis
  • Osteomyelitis
  • Perthes
  • SUFE
  • Toddlers fracture
  • Soft tissue injury
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2
Q

What are less common causes of limp?

A
  • NAI
  • Tumour
  • Endocrinopathies
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3
Q

What pathologies are common in the 0-3 years?

A
  • Septic arthritis
  • Osteomyelitis
  • DDH
  • Toddlers fracture
  • Soft tissue injury
  • NAI
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4
Q

What pathologies are common in the 3-10 years?

A
  • Trauma ( bone/ ST)
  • Septic arthritis
  • Transient synovitis
  • Perthes disease
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5
Q

What pathologies are common in the 11-15 years?

A
  • Trauma (stress)
  • Septic arthritis
  • Osteomyelities
  • SUFE
  • Perthes
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6
Q

What other types of pathology can impact the MSK system of children?

A
  • Sickle cell
  • ST/ spine infection
  • Metabolic disease-
  • Neoplastic
  • Anatomical
  • Rheumatological
  • Neuromuscular
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7
Q

What does SUFE stand for?

A

Slipped upper femoral epiphysis

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8
Q

How is SUFE defined?

A

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

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9
Q

Where in the physis foes SUFE occur?

A

Through the (widened) zone of hypertrophy in the physis

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10
Q

What is the epidemiology of SUFE?

A
  • Age range 9-16 years
  • Males mean=13.5 years
  • Female mean= 12 years
  • M:F 3:2
  • Incidence 2-4/100,000
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11
Q

What is SUFE due to?

A

Increased load, weak physis or both

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12
Q

What is the aetiology of SUFE?

A

Idiopathic

  • Adolescence
  • Delayed bone age
  • Increased weight

Secondary to underlying disorder (GH-IGF axis)

  • Hypothyroidism
  • Hypogonadism
  • Renal osteodystrophy
  • Growth hormone therapy
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13
Q

What history dies SUFE present with?

A
  • Pain- groin/ thigh/ knee
  • Limp
  • Trauma
  • ER deformity
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14
Q

What may be found on physical exam of SUFE?

A
  • Body habitus
  • Externally rotated extremity
  • Obligatory external rotation in flexion
  • ROM limited by pain
  • Healing arthroscopy portals on ipsilateral knee
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15
Q

What may be seen on radiology of SUFE/

A
  • Trethowan’s / Klein’s line
  • More obvious on lateral view
  • Widened physis
  • Horizontal physis (flexion contracture)
  • Knee x-rays are usually normal!
  • Blanch sign of Steel
  • Or just an obvious slip
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16
Q

What are the key summary points for SUFE?

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
17
Q

How is SUFE treated?

A

Percutaneous screw fixation

18
Q

What history is associated with 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
19
Q

What examination should be carried out for suspected infection?

A
  • Do they look sick?
  • Limp?
  • Absolute refusal to weight bear?
  • Localising area: ankle/tibia/knee/thigh/hip
  • Hip: obligatory ER?, Which movements hurt
  • Ankle: distal tibia or joint line?
  • Knee: joint line or metaphyseal are
  • Upper limb diffuse
20
Q

What is the differential diagnosis for suspected infection?

A
  • Transient synovitis
  • Osteomyelitis
  • Septic arthritis
  • Sarcoma
  • Mysoitis
  • Osteoid osteoma
  • Abscess
  • Inflammatory arthropathy
21
Q

What initial investigations should be done for suspected infection?

A
  • Temperature
  • X-ray
  • USS

Bloods

  • WCC
  • CRP
  • ESR
  • CK
  • Cultures
22
Q

How does septic arthritis present?

A
  • Limping
  • Pseudoparalysis
  • Swollen, red joint
  • Refusal to move joint
  • Pain
  • Temperature
23
Q

What is the distribution of septic arthritis?

A
  • Knee: 37%
  • Hip: 33%
  • Ankle: 13%
  • Shoulder: 8%
  • Elbow: 5%
  • Wrist: 3%
  • Sacroiliac 1%
24
Q

What are the possible routes of entry for septic arthritis?

A
  • Haematogenous spread
  • Dissemination from osteomyelitis
  • Spread from adjacent soft tissue infection
  • Consequence of diagnostic or therapeutic measures (injections)
  • Penetrating damage by puncture or trauma
25
Q

What investigations should be done for septic arthritis?

A
  • FBC and differential (Raised WCC >12,000mm^3)
  • ESR (>50 mm/hr)
  • CRP
  • Blood Cultures (+ve in 30-50%)
  • Ultrasound (always be present)
  • Synovial fluid (WCC>50,000mm^3, Gram stain, culture)
26
Q

What presenting variables help to direct in diagnosis?

A
  • Fever
  • Ability to weight bear
  • ESR
  • CRP
  • Serum WCC
  • Joint space
27
Q

How is septic arthritis treated?

A
  • Aspiration
  • Arthroscopy
  • Arthrotomy
  • IV antibiotics
28
Q

What organism is the typical cause of septic arthritis?

A

Staph aureus

29
Q

What is the epidemiology of osteomyelitis?

A
  • Declining
  • 2-13/100,000 incidence
  • Mean age 6 years (10 years for pelvic)
30
Q

What risk factors are there for osteomyelitis?

A
  • Blunt trauma

- Recent infection

31
Q

What is the pathogenesis of acute haematogenous osteomyelitis?

A

Vascular anatomy

  • Vascular loops
  • Terminal branches

Cellular anatomy
-Inhibited phagocytosis (low pO2)

Trauma
-A factor in 30%

32
Q

How does osteomyelitis present?

A
  • Pain
  • Localised symptoms
  • Fever
  • Reduced ROM
  • Reduced weight bearing
33
Q

What is the most common organism involved in osteomyelitis?

A

Staph aureus

34
Q

What are the 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
35
Q

How does transient synovitis present?

A
  • Limping, often touch weight bearing
  • History of viral infection eg URTI/ ear
  • Apyrexial
  • Allowing joint to be examined
  • Low CRP, normal WCC
  • May have joint infusion
  • NOT THAT UNWELL
36
Q

What features raise concerns about neoplasms?

A
  • Night pain
  • Often incidental trauma
  • Stops doing sport/ going out
  • Sweats and fatigue
  • Abnormal blood results- low Hb, atypical blood film, atypical platelets
  • Get a paediatricians/ oncology opinion

Systems: MSK AB (43 decks)

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