The Limping Child Flashcards
what are the differential diagnoses of a child with a limp?
transient synovitis septic arthritis perthes SUFE soft tissue injury tumour non-accidental injury
what questions should you ask in the history of a child with a limp?
duration and progression of limp? recent trauma? associated pain and its characteristics? accompanying weakness? time of day when limp is worse? can he child walk or bear weight? has it interfered with daily living? presence of systemic features?
what are the most common causes of;
- antalgic gait?
- abductor lurch?
- equine gait?
- circumduction gait?
- trauma, overuse syndrome, infection
- cerebral palsy, hip dysplasia
- cerebral palsy, idiopathic toe walker, club foot
- leg length inequality
what would you want to find out in the history in order to differentiate the septic arthritis, transient synovitis and osteomyelitis?
limp pain general malaise / loss of appetite temperature recent URTI/ear infection trauma pseudoparalysis
if you suspect an infection then what investigations would you carry out?
bloods: WCC, CK, CRP, ESR temperature blood cultures x-ray USS
what is the presentation of septic arthritis?
limp pain pseudoparalysis swollen, red joint refusal to move joint temperature
what is the presentation of transient synovitis?
limping but often able to weight bare slightly unwell pyrexial history of viral infection allowing joint to be examined low CRP, normal WCC may have joint effusion
what are the causes/ routes of entry for septic arthritis?
haematogenous spread dissemination from osteomyelitis spread from adjacent soft tissue infection diagnostic or therapeutic meausres penetrating damage by puncture or trauma
what is the diagnostic procedure for septic arthritis?
aspiration of synovial fluid
- WCC
- gram stain
- culture
what’s the difference in the blood results with transient synovitis and septic arthritis?
in transient synovitis their WCC is normal and CRP is low
whereas in septic arthritis CRP, WCC and ESR is elevated
what is the Kosher criteria for septic arthritis?
pyrexia > 38
no weight bearing
WBC > 12,000/ml
ESR > 40mm/hr
what is the treatment for septic arthritis?
aspiration
arthroscopy
arthrotomy
antibiotics IV (for 2 weeks)
what is the most common causative organism for septic arthritis?
staph aureus
what is acute haematogenous osteomyelitis?
bone infection with < 2 weeks duration
infection spreads in the metaphysis where blood supply is rich but sluggish
femur and tibia are most affected
if you suspected osteomyelitis, what imaging techniques would you carry out to confirm the diagnosis?
bone scan
bone biopsy
MRI
CT
when would you consider surgery in osteomyelitis?
biopsy in equivocal cases debridement of dead tissue aspiration for culture drainage of a subperiosteal abscess drainage of a joint sepsis failure to improve
what features raise concern of a neoplasm in the bone?
night pain often incidental trauma stops doing sport/ going out sweats and fatigue abnormal blood tests: low Hb, atypical blood film, atypical platelets
what is the route of spread of infection which is responsible for osteomyelitis?
haematogenous
if someone has had osteomyelitis for 3 weeks would like be termed acute or chronic?
chronic
acute < 2 weeks
what are the risk factors for osteomyelitis?
trauma
recent infection
what are the complications of osteomyelitis?
growth disturbance
deformity
death
at what site of bone does the organism infect causing osteomyelitis ?
metaphysis because the blood is rich but sluggish
what is the presentation of osteomyelitis?
insidious presentation pain fever decreased range of movement decreased weight bearing localised symptoms
what is the treatment for osteomyelitis?
antibiotics surgery (in some cases)
what are the most common sites of osteomyelitis?
femur
tibia
what is the mean age of prevalence of osteomyelitis?
6 years old
