The Acute Limping Child Flashcards
Causes of limp in 0-3 years old
septic arthritis osteomyelitis toddler's fracture DDH NAI soft tissue injury
What does NAI stand for?
Non-accidental injury
Causes of limp in 3-10 years old
Trauma - bone/ST
Septic arthritis
Perthes disease
Transient synovitis
Causes of limp in 11-15 years old
Trauma - stress Septic arthritis osteomyelitis SUFE Perthes
Causes of limp in children
septic arthritis osteomyelitis Perthes SUFE Toddler's fracture Soft tissue injury NAI Tumour endocrinopathies sickle cell ST/spine infection metabolic disease neoplastic anatomical rheumatological neuromuscular
What does SCFE/SUFE stand for?
Slipped upper/capital femoral epiphysis
Pathology of SCFE/SUFE
Posteriomedial displacement of the proximal femoral epiphysis in relation to the neck
What age range can get SUFE/SCFE?
9-16 years; so older children
What gender mostly gets SUFE/SCFE?
M > F, 60:40
Causes of SUFE/SCFE
Idiopathic - adolescence - delayed bone age - increased weight Secondary to underlying disorder - hypothyroidism - hypogonadism - renal osteodystrophy - growth hormone therapy
What does SUFE/SCFE have a relation to?
Obesity
Presentation of SUFE/SCFE
Pain - groin/thigh/knee Limp Trauma ER deformity + on flexion + on gait (externally rotated extremity) ROM limited by pain
Treatment of SUFE/SCFE
Percutaneous screw fixation
Who is SUFE/SCFE most commonly seen in?
Adolescent obese males
A presenting history which would flag a concern or would help to exclude it would include;
limp (age dependent) pain general malaise/loss of apetite/listless Temperature Recent UTI/ear infections trauma pseudoparalysis
Presentation of septic arthritis in children
Limping ability to weight bear pseudoparalysis swollen, red joint refusal to move joint pain temperature
Routes of infection of septic arthritis
Haematogenous Dissemination of osteomyelitis Spread from adjacent soft tissue infections diagnostic or therapeutic measures penetrating damage by puncture of trauma
investigations of septic arthritis in children
FBC + differential - WCC > 12,000 ESR > 50 CRP Blood cultures (+ve 30-50%) Xray USS Synovial fluid (WCC > 50,000, gram stain, culture)
Treatment of septic arthritis
Aspiration
Arthroscopy
Arthrotomy
Antibiotics
Mean age of osteomyelitis in children
6 y/o
10 y/o pelvis
Risk factors for osteomyelitis
blunt trauma
recent infection
Presentation of osteomyelitis
pain localised signs/symptoms fever reduced ROM reduced weight bearing
Investigations of osteomyelitis
radiography Tc99 bone scan MRI CT USS
Most common site of osteomyelitis in children
femur
Treatment of osteomyelitis
Antibiotics
Surgery
Presentation of transient synovitis in children
NOT THAT UNWELL limping often touch weight bearing history of viral infection - UTI/ear Apyrexial - no fever low CRP Normal WCC May have joint effusion
Definition of arthalgia
joint pain
What is transient synovitis?
Transient inflammation of the synovium of the hip causing arthalgia and arthritis. Most common cause of acute hip pain in children aged 3-10 years
3 factors of the pathogenesis of Albright osteodystrophy
- vascular anatomy
- vascular loops, terminal branches - cellular anatomy
- inhibited phagocytosis (low PO2) - Trauma
Features that raise concern of neoplasm
night pain often incidental trauma stop doing sport/going out sweats and fatigue Abnormal blood results - low Hb, atypical blood film, atypical platelets
Where does Perthes Disease affect?
The hip
Pathology of perthes disease
occurs when blood supply to the rounded head of the femur is temporarily disrupted and this leads to a vascular necrosis, where the bone cells die
Presentation of perthes disease
Pain - in hip or groin - referred to thigh or knee - worsens with activity - relieved by rest painful muscle spasms
Treatment of perthes disease
observation anti-inflammatory mediators limiting activity physio casting and bracing possibly surgery
