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Year 3 MSK (JK) > The limping child > Flashcards

The limping child Flashcards

1
Q

Common causes

A

osteomyelitis - septic arthritis - SUFE - toddler fracture - soft tissue injury

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2
Q

Less common causes

A

NAI, tumour ,endocrinopathies

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3
Q

0-3yrs

A 
fractures
soft tissue injury 
septic arthritis 
osteomyelitis 
DDH 
NAI
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4
Q

3-10yrs

A

trauma
septic arthritis
transient synovitis
perthes disease

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5
Q

other causes of limping - age related pathologies

A

sickle cell
ST/spinal infection
metabolic, neoplasia, rheumatic, neuromuscular

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6
Q

SUFE/SCFE stands for

A

slipped upper/capital femoral epiphysis

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7
Q

What happens in SUFE

A

posteromedial displacement of proximal epiphysis in relation to the neck

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8
Q

Where in the physis does SUFE occur?

A

through zone of hypertrophy

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9
Q

Epidemiology of SUFE

A

age 9-16 (males 13.5, girls 12)
sex - 60% male
2-4/100 000

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10
Q

Brief description of SUFE aetiology

A

increased load or weak physis or both

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11
Q

idiopathic SUFE

A

adolescent, OBESITY, delayed bone age

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12
Q

secondary SUFE

A

GH-1GF1 axis eg hypothyroid, hypogonadism, renal osteodystrophy, growth hormone therapy

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13
Q

History - SUFE

A

pain in groin, thigh, knee
limp
trauma

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14
Q

physical exam - SUFE

A
  1. body habitus
  2. externally rotated extremity
  3. ROM limited by pain
  4. obligatory external rotation in flexion
  5. healing arthroscopy portals on ipsilateral knee
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15
Q

Radiology - SUFE

A
  • Trethowan/Klein’s line in lateral view
  • widened physis
  • knee x-rays normal
  • obvious slip
  • blanch sign of steel
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16
Q

SUFE summary

A 
older child 
hip/thigh/knee pain 
acute, acute on chronic
no infection 
limp 
external rotation gait 
knee flex into ER 
frog lateral x-ray 
percutaneous screw fixation
17
Q

4 infection and inflammations

A

septic arthritis
osteomyelitis
muscle abscess
transient synovitis

18
Q

History of infection and inflammation

A

limp - age, pain, temperature, malaise, loss of appetite, trauma, recent URTI/ear infection, pseudoparalysis

19
Q

Examination of infection/inflammation

A

look sick? limp? absolute refusal to weight bear?localise area, upper limb disuse

20
Q

ankle - infection/inflammation

A

distal tibia or joint line?

21
Q

knee - infection/inflammation

A

joint line or metaphyseal area

22
Q

hip - infection/inflammation

A

obligatory ER?

which movements hurt?

23
Q

Diff diagnosis - infection/inflammation

A

transient synovitis, osteomyelitis, septic arthritis

something else?…sarcoma, myositis, abscess, osteoma

24
Q

Initial investigations - infection/inflammation

A

temperature
x-ray
USS
bloods - CRP, ESR, WCC, CK, Cultures

25
Q

septic arthritis signs and symptoms

A

limping - pseudoparalysis - swollen, red joint - pain - temperature - refuse to move joint

26
Q

Most common location of septic arthritis

A

KNEE, then hip

ankle, shoulder, elbow, wrist, SI - rare

27
Q

5 routes of bacterial entry for septic arthritis

A 
1 - haematogenous 
2 - dissemination from osteomyelitis 
3 - soft tissue infection 
4 - diagnostic/therapeutic measures 
5 - penetrating trauma
28
Q

Investigations - septic arthritis

A

FBC, ESR, CRP, x-ray, blood cultures, USS, synovial fluid analysis eg WCC, gram stain and culture

29
Q

Presenting variables in septic arthritis

A

fever - ESR - CRP - ability to weight bear - serum WCC - joint space

30
Q

treatment of septic arthritis

A

aspiration
arthroscopy
arthrotomy
antibiotics

31
Q

usual causative organism of septic arthritis

A

staph aureus

32
Q

osteomyelitis epidemiology

A

declining, 2-13/100 000
6 years old (10yrs pelvic)
blunt trauma/recent infection

33
Q

3 factors for osteomyelitis pathogenesis

A

RARE IN ADULTS
vascular anatomy - vascular loops and terminal branches
cellular - inhibited phagocytosis
trauma - 30%

34
Q

osteomyelitis symptoms

A

pain, fever, decreased ROM, decreased weight bearing

35
Q

investigations for osteomyelitis

A

ESR

CRP, WCC, Tc99 bone scan, MRI, CT, USS

36
Q

osteomyelitis surgery

A 
aspiration for culture 
drain subperiosteal abscess 
drain joint sepsis 
debride dead tissue 
biopsy
37
Q

When is it transient synovitis?

A

limp, touch weight bear
NOT THAT UNWELL
joint infusion
allow joint to be examined

38
Q

Concerning signs - neoplasm?

A 
night pain 
stopping sports 
incidental trauma 
sweats and fatigue 
low Hb, atypical blood film and platelets

Year 3 MSK (JK) (30 decks)

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