The limping child Flashcards
What are the common causes of limping children?
Septic arthritis Osteomyelitis Perthes SUFE Toddler's fracture Soft tissue injury
What are the less common causes of a limping child?
Non accidental injury
Tumour
Endocrinopathies
What does SUFE stand for?
Slipped upper femoral epiphysis
What is SUFE?
Posteriomedial displacement of proximal femoral epiphysis in relation to the neck
Who is SUFE seen in?
9-16 year olds, typically over 11s
What is SUFE associated with?
Growth spurt
Obesity
What causes SUFE?
Increased load
Weak physis
What are the signs and symptoms of SUFE?
Pain- groin, knee, thigh Limited range of movement Limp History of trauma External rotation, esp on flexion
What is the investigation for SUFE?
Frog lateral xrays
What is the treatment of SUFE?
Operative- pin in situ
What causes septic arthritis?
Typically staph aureus
What is the presentation of septic arthritis?
Limping with no weight bearing Pseudoparalysis Swollen, red joint Pain Feverish
What are the common route of infection in septic arthritis?
Haematenogous spread
Dissemination from osteomyelitis
Spread from adjacent soft tissue infection
What investigations are done for septic arthritis?
Observation
Temperature
Bloods- WCC, CRP, ESR, Creatinine kinase, cultures
Ultrasound
What is the treatment of septic arthritis?
IV antibiotics, then switch to oral
Surgical- wash out joint
What is the most common causative organism of osteomyelitis?
Staph aureus
What is the presentation of osteomyelitis?
Pain Localised signs and symptoms Fever in 60% Have better weight bearing and ROM Less unwell than septic arthritis, but "not right"
What investigations are done for osteomyelitis?
Observation
Temperature
Bloods- WCC, CRP, ESR, creatinine kinase, cultures
US
What is the treatment of osteomyelitis?
Antibiotics
Surgical
What are the indications for surgery in osteomyelitis?
Collection in periosteum
Infection spreads to joint
Atypical bacteria
Debridement of dead tissue
What is transient synovitis?
Inflammation of joint secondary to virus
What is the presentation of transient synovitis?
Limp- hobbling, will weight bear
No temperature
Recent viral infection
Normally fairly well
What investigations are done for transient synovitis?
Observation
Temperature
Occasionally US