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Year 3 > The Acute Limping Child > Flashcards

The Acute Limping Child Flashcards

1
Q

common causes of a limping child

A 
septic arthritis
osteomyelitis
Perthes
SUFE
Toddlers fracture
soft tissue injury
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2
Q

less common causes of a limping child

A

NAI
Tumour
endocrinopathies

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3
Q

age related limping pathologies: 0-3

A 
septic arthritis
osteomyelitis
DDH
toddlers fracture
soft tissue injury
NAI
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4
Q

age related limping pathologies: 3-10

A

trauma (bone/ST)
septic arthritis
transient synovitis
perthes disease

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5
Q

age related limping pathologies: 11-15

A 
trauma (Stress)
septic arthritis
osteomyelitis
SUFE
Perthes
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6
Q

age related limping pathologies: any age

A 
sickle cell
ST/spine infection
metabolic disease
neoplastic
anatomical
rheumatological
neuromuscular
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7
Q

what is a SUFE?

A

posteriomedial displacement of the prox femoral epiphysis in relation to the neck. often occurs through the (widened) zone of hypertrophy in the physis

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8
Q

epidemiology of a SUFE

A

9-16
male
incidence 2-4/100,00

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9
Q

causes of SUFE: idiopathic

A

adolescence
delayed bone age
increased weight

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10
Q

causes of SUFE: secondary to underlying disorder

A 
GH-IGF axis
hypothyroidism
hypogonadism
renal osteodystrophy
growth horome deiciency
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11
Q

Hx of SUFE

A

pain - groin, thigh, knee
limp
trauma
ER deformity

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12
Q

examination in SUFE

A 
body hiatus
externally rotated extremity
obligatory external rotation in flexion
ROM limited by pain
healing arthroscopy portals on ipsilateral knee
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13
Q

radiology in SUFE

A 
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
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14
Q

causes of infection and inflammation in a limping child

A

septic arthritis
osteomyelitis
transient synovitis
muscle abscess

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15
Q

Hx in infection and inflammation in a limping child

A 
limp (age dependent)
pain
general malaise/loss of appetite
temp
recent URTI/ear infection
trauma
psuedoparalysis
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16
Q

examination of infection and inflammation in a limping child

A 
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
17
Q

DDx of infection and inflammation in a limping child

A

transient synovitis
osteomyelitis
septic arthritis
(sarcoma, myositis, osteoid osteoma, abscess, inflammatory arthropathy)

18
Q

intial investigations in infection and inflammation in a limping child

A

temp
xray
USS
bloods - WCC, CRP, ESR, CK,cultures

19
Q

signs and symptoms of septic arthris

A 
limping
pseudoparalysis
swollen, red joint
refusal to move joint
pain
temperature
20
Q

investigations for septic arthritis

A 
• 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
21
Q

treatment of septic arthritis

A
  • Typically, staph. A infection
  • Aspiration
  • Arthroscopy – knee/shoulder/ankle
  • Arthrotomy
  • Antibiotics
22
Q

mean age for osteomyelitis in children

A

6

10 for pelvic

23
Q

risk factors for childhood osteomyelitis

A

blunt trama

recent infection

24
Q

pathogenesis of acute haematogenous osteomyelitis

A 
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%
25
Q

organism that is most common cause of osteomyelitis

A

staph a

26
Q

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
27
Q

discuss transient synovitis

A
  • 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
28
Q

what factors would raise concern of neoplasm in children’s ortho?

A
  1. Night pain
  2. Often incidental trauma
  3. Stops doing sport/going out
  4. Sweats and fatigue
  5. Abnormal blood results – low Hb, atypical blood film, atypical platelets
  6. Get a paediatrician/oncology opinion
29
Q

what is Perthes disease?

A

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.

30
Q

what is DDH?

A

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.

Year 3 (164 decks)

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