The acute limping child Flashcards
What are common causes of limp?
Septic arthritis Osteomyelitis Perthes SUFE Toddlers fracture Soft tissue injury
What are less common causes of limp?
Non-accidental injury
Tumour
Endocrinopathies
What pathologies can affect children age 0-3?
Septic arthritis Osteomyelitis Developmental dysplasia of the hip Toddlers fracture Soft tissue injury Non accidental injury
What are possible causes of limp in children age 3-10?
Trauma Osteomyelitis Septic arthritis Transient synovitis Perthes disease
What are possible causes of limp in children aged 11-15?
Trauma
Septic arthritis
Osteomyelitis
SUFE
What is SUFE?
Slipped upper femoral epiphysis
What is the general aetiology of SUFE?
Increased load, weak physis, or both
What can cause secondary SUFE?
Hypothyroidism
Hypogonadism
Renal osteodystrophy
Growth hormone therapy
What history should be taken in suspected SUFE?
Limp Pain - groin, knee, thigh General malaise/loss of appetite Temperature Recent URTI/ear infections Trauma Pseudoparalysis Listen to parent
What would be findings in physical exam of SUFE?
Body habitus Externally rotated extremity Obligatory external rotation in flexion Range of movement limited by pain Healing arthroscopy portals on ipsilateral knee
What infection/inflammation can cause limp?
Septic arthritis
Osteomyelitis
Transient synovitis
Muscle abscess
What would you expect to find in the history of someone with an infection?
Limp - age dependent Pain General malaise Temperature Recent URTI Trauma Pseudoparalysis Listen to the parent
What would you expect to find in examination of someone with infection?
Do they look sick
Limp
Refusal to bear weight
Localising area
What are initial investigations for infection?
Temp
X-ray
USS
Bloods - WCC, CRP, cultures
How would septic arthritis specifically present?
Limping Pseudoparalysis Swollen red joint Refusal to move joint Pain Temperature
What is the most common causative organism for septic arthritis?
Staph aureus
What are indications for surgery in osteomyelitis?
Aspiration for culture Drainage for subperiosteal abscess Drainage of joint sepsis Debridement of dead tissue Biopsy in equivocal cases
What are features of transient synovitis?
Limping - touch weight bearing Slightly unwell History of viral infection Apyrexial Allowing joint to be examined Low CRP, normal WCC May have joint effusion Not that unwell
What features raise concern of neoplasm?
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/oncologist opinion
What should be asked in the history of a limping child?
Duration and progression of limp Recent trauma and mechanism Associated pain and SOCRATES Accompanying weakness Time of day when worse Can child walk or bear weight Has limp interfered with normal activities Systemic symptoms? Medical history - birth history, immunisation, nutritional history, developmental history Drug history, allergies Family history
What is antalgic gait?
Shortened stance phase
What types of gait may present in limp?
Antalgic
Abductor lurch
Equinus
Circumduction
What is equinus gait?
Toe to heel gait
What is circumduction gait?
Circumduction during swing phase
