Explain antalgic gait
Occurs when the "stance phase" of gait is shortened, usually because of pain during weight bearing
Remember: normal gait consists of two phases (swing and stance, with stance accounting for ~60% of the cycle)
The most common nontraumatic hip pathology in adolescents
Slipped Capital Femoral Epiphysis (SCFE)
Hip pathology will frequently present with pain in the...
groin, thigh, and knee
Pain with internal rotation of the hip
External rotation on passive flexion
What is the most sensitive mark (on PE) of hip pathology in children
Restricted internal rotation followed by a lack of abduction
The FABER test can find pathology located in the...
Fever greater than ___ and ESR gerater than ___ is 97% sensitive for septic hip joint
Fever > 99.5
ESR > 20
Monoarticular with systemic signs (eg, fever)
Think septic arthritis
Children with septic hip joint will often lay with their hip flexed, abducted, and externally rotated
What are the most common pathogens involved in children with septic hip?
< 4 months: GBS and Staph aureus
4 months - 5 years: Staph aureus and Strep pyogenes
Spiral fracture of the tibia that results from twisting while the foot is planted
Setting = acute limp or change in ambulation
*If the child had a painless limp from the time they learned to walk think congenital dysplasia
A self-limited inflammatory response that often follows a viral infection, leading to hip pain in children ages 3-10
Low-grade to no fever, normal WBC, normal ESR
Used to assess risk for septic arthritis in children
- Fever > 101.3
- Nonweight bearing
- ESR > 40
- WBC > 12,00
Purulent aspirate with WBC > 50,000
Yellow/clear aspirate with WBC <10,000
Avascular necrosis of the femoral head
AKA Legg-Calvé-Perthes (LCP)
More common in boys than girls
Although any disruption of blood flow to the femoral capital epiphysis, such as trauma or infection, can cause avascular necrosis the etiology of LCP is unknown
Capital Femoral Epiphysis
Growth plate that connects the metaphysis (femoral head) to the diaphysis (shaft of the femur)
Treatment for SCFE
Surgical pinning (do not let them walk after making diagnosis)
33% will develop avascular necrosis and 33% will develop SCFE in the contralateral hip
Pain that wakens a child at night
Suspicious for malignancy
"Growing pains" is a diagnosis of exclusion (it should be considered if the pain is only at night, is bilateral, and if no other pathology is found)
A 6-year-old young boy is brought in for evaluation of a painful hip. He has been limping and not wanting to walk for the past 2 days. He has had no obvious injury. He feels better after taking ibuprofen. He has not had a fever, although he had "the flu" last week. Vitals are normal. Some pain with internal rotation. He walks with a pronounced limp. Can he be sent home?
After getting a CBC and ESR
If they are in normal limits he likely has transient synovitis and can be treated with an NSAID with the expectation of a recovery in a few days
A 6-year-old boy has a 2-month history of slight limp. No PMHx and no medications. Normal vitals, but an antalgic gait and decreased ROM in the L hip (internal). Mild pain on palpation of the anterior capsule on the L side. X-ray shows fragmentation of the femoral head. What is the most likely diagnosis?
Often a self-healing disorder. Treatment is focused on limiting pain and avoiding functional loss.
Physical exam findings of suprapubic pain and costovertebral tenderness
Suggestive of UTI and most likely acute pyelonephritis
Most common organisms leading to UTIs
Drugs that are commonly associated with "drug fever"
A rare AD disorder charaterized by fever > 104, tachycardia, metabolic acidosis, rhabdomyolysis, and calcium accumulation in skeletal muscle leading to rigidity
May occur up to 24 hrs after exposure to anesthetic agents such as halothane and succinylcholine
Treatment: discontinue offending agents, supportive therapy (antipyretics, oxygen hyperventilation, cooling blankets, sodium bicarbonate, and dantrolene IV)
Most common postoperative complication
5 W's of post-op fever
Wonder where/drugs (Abscess or Fever)
Causes of immediate postoperative period
If fever occurs within 36 hours post-laparotomy what two important infectious etiologies should you consider?
Bowel injury with leakage of gastrointestinal contents
Invasive soft-tissue wound infection (caused by β-hemolytic streptococci or Clostridium species)
*Toxic Shock Syndrome caused by Staph aureus is a rare condition
Postoperative pneumonia is typically caused by
Enterobacteriaceae and S aureus or Enterobacteriaceae and Streptococci
When and which type of antibiotics do you give for aspiration penumonia?
Antibiotics are typically given following a witnessed aspiration and discontinued after 48-72 hours with no development of infiltrates
Gram (-) coverage is required, with the current choice being piperacillin/tazobactam or ticarcillin/clavulanate
Pain in the calf on foot dorsiflexion = DVT
Fever caused by DCT usually occurs on the 5th postoperative day