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MSK clinical > The Limping Child > Flashcards

The Limping Child Flashcards

1
Q

what are the differential diagnoses of a child with a limp?

A 
transient synovitis
septic arthritis
perthes
SUFE
soft tissue injury 
tumour
non-accidental injury
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2
Q

what questions should you ask in the history of a child with a limp?

A 
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?
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3
Q

what are the most common causes of;

  • antalgic gait?
  • abductor lurch?
  • equine gait?
  • circumduction gait?
A
  • trauma, overuse syndrome, infection
  • cerebral palsy, hip dysplasia
  • cerebral palsy, idiopathic toe walker, club foot
  • leg length inequality
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4
Q

what would you want to find out in the history in order to differentiate the septic arthritis, transient synovitis and osteomyelitis?

A 
limp
pain
general malaise / loss of appetite 
temperature
recent URTI/ear infection
trauma
pseudoparalysis
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5
Q

if you suspect an infection then what investigations would you carry out?

A 
bloods: WCC, CK, CRP, ESR
temperature
blood cultures 
x-ray
USS
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6
Q

what is the presentation of septic arthritis?

A 
limp
pain
pseudoparalysis
swollen, red joint
refusal to move joint
temperature
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7
Q

what is the presentation of transient synovitis?

A 
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
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8
Q

what are the causes/ routes of entry for septic arthritis?

A 
haematogenous spread 
dissemination from osteomyelitis
spread from adjacent soft tissue infection
diagnostic or therapeutic meausres
penetrating damage by puncture or trauma
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9
Q

what is the diagnostic procedure for septic arthritis?

A

aspiration of synovial fluid

  • WCC
  • gram stain
  • culture
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10
Q

what’s the difference in the blood results with transient synovitis and septic arthritis?

A

in transient synovitis their WCC is normal and CRP is low

whereas in septic arthritis CRP, WCC and ESR is elevated

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11
Q

what is the Kosher criteria for septic arthritis?

A

pyrexia > 38
no weight bearing
WBC > 12,000/ml
ESR > 40mm/hr

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12
Q

what is the treatment for septic arthritis?

A

aspiration
arthroscopy
arthrotomy
antibiotics IV (for 2 weeks)

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13
Q

what is the most common causative organism for septic arthritis?

A

staph aureus

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14
Q

what is acute haematogenous osteomyelitis?

A

bone infection with < 2 weeks duration
infection spreads in the metaphysis where blood supply is rich but sluggish
femur and tibia are most affected

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15
Q

if you suspected osteomyelitis, what imaging techniques would you carry out to confirm the diagnosis?

A

bone scan
bone biopsy
MRI
CT

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16
Q

when would you consider surgery in osteomyelitis?

A 
biopsy in equivocal cases 
debridement of dead tissue
aspiration for culture
drainage of a subperiosteal abscess
drainage of a joint sepsis
failure to improve
17
Q

what features raise concern of a neoplasm in the bone?

A 
night pain
often incidental trauma
stops doing sport/ going out
sweats and fatigue 
abnormal blood tests: low Hb, atypical blood film, atypical platelets
18
Q

what is the route of spread of infection which is responsible for osteomyelitis?

A

haematogenous

19
Q

if someone has had osteomyelitis for 3 weeks would like be termed acute or chronic?

A

chronic

acute < 2 weeks

20
Q

what are the risk factors for osteomyelitis?

A

trauma

recent infection

21
Q

what are the complications of osteomyelitis?

A

growth disturbance
deformity
death

22
Q

at what site of bone does the organism infect causing osteomyelitis ?

A

metaphysis because the blood is rich but sluggish

23
Q

what is the presentation of osteomyelitis?

A 
insidious presentation
pain
fever
decreased range of movement 
decreased weight bearing 
localised symptoms
24
Q

what is the treatment for osteomyelitis?

A 
antibiotics 
surgery (in some cases)
25
Q

what are the most common sites of osteomyelitis?

A

femur

tibia

26
Q

what is the mean age of prevalence of osteomyelitis?

A

6 years old

MSK clinical (25 decks)

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