The Acute Limping Child Flashcards
common causes of a limping child
septic arthritis osteomyelitis Perthes SUFE Toddlers fracture soft tissue injury
less common causes of a limping child
NAI
Tumour
endocrinopathies
age related limping pathologies: 0-3
septic arthritis osteomyelitis DDH toddlers fracture soft tissue injury NAI
age related limping pathologies: 3-10
trauma (bone/ST)
septic arthritis
transient synovitis
perthes disease
age related limping pathologies: 11-15
trauma (Stress) septic arthritis osteomyelitis SUFE Perthes
age related limping pathologies: any age
sickle cell ST/spine infection metabolic disease neoplastic anatomical rheumatological neuromuscular
what is a SUFE?
posteriomedial displacement of the prox femoral epiphysis in relation to the neck. often occurs through the (widened) zone of hypertrophy in the physis
epidemiology of a SUFE
9-16
male
incidence 2-4/100,00
causes of SUFE: idiopathic
adolescence
delayed bone age
increased weight
causes of SUFE: secondary to underlying disorder
GH-IGF axis hypothyroidism hypogonadism renal osteodystrophy growth horome deiciency
Hx of SUFE
pain - groin, thigh, knee
limp
trauma
ER deformity
examination in SUFE
body hiatus externally rotated extremity obligatory external rotation in flexion ROM limited by pain healing arthroscopy portals on ipsilateral knee
radiology in SUFE
Trethowan's/Klein's line more obvious on lateral view widened physis horizontal physis (felxion contracture) knee x ray usually normal blanch sign of Steel sometimes just an obvious slip
causes of infection and inflammation in a limping child
septic arthritis
osteomyelitis
transient synovitis
muscle abscess
Hx in infection and inflammation in a limping child
limp (age dependent) pain general malaise/loss of appetite temp recent URTI/ear infection trauma psuedoparalysis
examination of infection and inflammation in a limping child
do they look sick? limp? absolute refusal to weight bear? localising area - ankle/tibia/knee/thigh/hio hip - obligatory ER? which movements hurt? ankle - distal or joint line knee - joint line or metaphyseal area upper limb disuse
DDx of infection and inflammation in a limping child
transient synovitis
osteomyelitis
septic arthritis
(sarcoma, myositis, osteoid osteoma, abscess, inflammatory arthropathy)
intial investigations in infection and inflammation in a limping child
temp
xray
USS
bloods - WCC, CRP, ESR, CK,cultures
signs and symptoms of septic arthris
limping pseudoparalysis swollen, red joint refusal to move joint pain temperature
investigations for septic arthritis
• FBC and differential WCC o Raised WCC > 12,000/mm3 • ESR > 50mm/hr • CRP • Blood cultures (+ve in 30-50%) • X-ray • USS – always be present • Synovial fluid Knee 37% Hip 33% Ankle 13% Shoulder 8% Elbow 5% Wrist 3% Sacroiliac 1% o WCC > 50,000/mm3 o Gram stain o Culture
treatment of septic arthritis
- Typically, staph. A infection
- Aspiration
- Arthroscopy – knee/shoulder/ankle
- Arthrotomy
- Antibiotics
mean age for osteomyelitis in children
6
10 for pelvic
risk factors for childhood osteomyelitis
blunt trama
recent infection
pathogenesis of acute haematogenous osteomyelitis
rare in adults • 3 factors o Vascular anatomy § Vascular loops § Terminal branches o Cellular anatomy § Inhibited phagocytosis (low pO2) o Trauma § A factor in 30%
organism that is most common cause of osteomyelitis
staph a
indications for surgery in osteomyelitis
- Aspiration for culture
- Drainage of subperiosteal abscess
- Drainage of joint sepsis
- Debridement of dead tissue
- Biopsy in equivocal cases
discuss transient synovitis
- Limping, often touch weight bearing
- Slightly unwell
- Hx of viral infection e.g. URTI/ear
- Apyrexial
- Allowing joint to be examined
- Low CRP, normal WCC
- May have joint infusion
- Not that unwell
what factors would raise concern of neoplasm in children’s ortho?
- 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 paediatrician/oncology opinion
what is Perthes disease?
Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis.
what is DDH?
Developmental dysplasia of the hip (DDH) is a condition where the “ball and socket” joint of the hip does not properly form in babies and young children. It’s sometimes called congenital hip dislocation or hip dysplasia.
