The Limping Child

Question 1

• children under age 10
• metaphyseal long bone, necrotic sequestrum
• Staph aureus the most common, hematogenous seeding
• acute phase reactants: WBC normal initially, CRP peaks at 2 days, SED elevated
• treat with 3-6 weeks antibiotics

Answer 1

osteomyelitis

Question 2

• hematogenous seeding, extension of osteomyelitis, trauma
• staph aureus, gonorrhea in adolescents usually the cause
• acute joint inflammation, external rotation to minimize pain
• fever and ill appearance
• elevated CRP and ESR
• widening of joint space, soft tissue swelling
• antibiotics, irrigation and drainage

Answer 2

septic arthritis

Question 3

• noninfectious, occurs in children 3-8 years old
• follows viral URI
• minimal limitation of range of motion
• ESR, CRP, WBC normal
• treat with rest and NSAIDS

Answer 3

transient/toxic synovitis

Question 4

• 2 to 12 years old males
• secondary to repeated microtrauma, hip irritability
• treat with rest and pain meds

Answer 4

avascular necrosis

Question 5

weight loss in children is a sign of ________

Answer 5

cancer

Question 6

• adolescent hip disorder
• epiphyseal fracture
• obese adolescents or tall kids after growth spurt
• chronic limp or acute pain
• leg in slight external rotation, limited internal rotation
• knee pain via obturator nerve
• surgical cannulated screw

Answer 6

slipped capital femoral epiphysis

Question 7

• overuse injury of patellar tendon on tibial tubercle

- inflammation, decrease stress to treat

Answer 7

osgood schlatter disease