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Systems: MSK AB > The Acute Limping Child > Flashcards

Flashcards in The Acute Limping Child Deck (36)
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1

What are common causes of limp?

-Septic arthritis
-Osteomyelitis
-Perthes
-SUFE
-Toddlers fracture
-Soft tissue injury

2

What are less common causes of limp?

-NAI
-Tumour
-Endocrinopathies

3

What pathologies are common in the 0-3 years?

-Septic arthritis
-Osteomyelitis
-DDH
-Toddlers fracture
-Soft tissue injury
-NAI

4

What pathologies are common in the 3-10 years?

-Trauma ( bone/ ST)
-Septic arthritis
-Transient synovitis
-Perthes disease

5

What pathologies are common in the 11-15 years?

-Trauma (stress)
-Septic arthritis
-Osteomyelities
-SUFE
-Perthes

6

What other types of pathology can impact the MSK system of children?

-Sickle cell
-ST/ spine infection
-Metabolic disease-
-Neoplastic
-Anatomical
-Rheumatological
-Neuromuscular

7

What does SUFE stand for?

Slipped upper femoral epiphysis

8

How is SUFE defined?

Posteromedial displacement of the proximal femoral epiphysis in relation to the neck

9

Where in the physis foes SUFE occur?

Through the (widened) zone of hypertrophy in the physis

10

What is the epidemiology of SUFE?

-Age range 9-16 years
-Males mean=13.5 years
-Female mean= 12 years
-M:F 3:2
-Incidence 2-4/100,000

11

What is SUFE due to?

Increased load, weak physis or both

12

What is the aetiology of SUFE?

Idiopathic
-Adolescence
-Delayed bone age
-Increased weight

Secondary to underlying disorder (GH-IGF axis)
-Hypothyroidism
-Hypogonadism
-Renal osteodystrophy
-Growth hormone therapy

13

What history dies SUFE present with?

-Pain- groin/ thigh/ knee
-Limp
-Trauma
-ER deformity

14

What may be found on physical exam of SUFE?

-Body habitus
-Externally rotated extremity
-Obligatory external rotation in flexion
-ROM limited by pain
-Healing arthroscopy portals on ipsilateral knee

15

What may be seen on radiology of SUFE/

-Trethowan’s / Klein’s line
-More obvious on lateral view
-Widened physis
-Horizontal physis (flexion contracture)
-Knee x-rays are usually normal!
-Blanch sign of Steel
-Or just an obvious slip

16

What are the key summary points for SUFE?

-Older child (rare but occasionally <10 yrs)
-Hip / thigh/ knee pain
-Acute, acute on chronic
-No clinical indicators of infection
-Limp, external rotation gait, knee flex into ER
-Frog lateral x-ray
-If x-ray positive should be referred for urgent review

17

How is SUFE treated?

Percutaneous screw fixation

18

What history is associated with infection?

-Limp (age dependent)
-Pain
-General malaise/ loss of appetite/ listless
-Temperature
-Recent URTI/ ear infections
-Trauma
-Pseudoparalysis
-Listen to the parent, they are usually right

19

What examination should be carried out for suspected infection?

-Do they look sick?
-Limp?
-Absolute refusal to weight bear?
-Localising area: ankle/tibia/knee/thigh/hip
-Hip: obligatory ER?, Which movements hurt
-Ankle: distal tibia or joint line?
-Knee: joint line or metaphyseal are
-Upper limb diffuse

20

What is the differential diagnosis for suspected infection?

-Transient synovitis
-Osteomyelitis
-Septic arthritis
-Sarcoma
-Mysoitis
-Osteoid osteoma
-Abscess
-Inflammatory arthropathy

21

What initial investigations should be done for suspected infection?

-Temperature
-X-ray
-USS

Bloods
-WCC
-CRP
-ESR
-CK
-Cultures

22

How does septic arthritis present?

-Limping
-Pseudoparalysis
-Swollen, red joint
-Refusal to move joint
-Pain
-Temperature

23

What is the distribution of septic arthritis?

-Knee: 37%
-Hip: 33%
-Ankle: 13%
-Shoulder: 8%
-Elbow: 5%
-Wrist: 3%
-Sacroiliac 1%

24

What are the possible routes of entry for septic arthritis?

-Haematogenous spread
-Dissemination from osteomyelitis
-Spread from adjacent soft tissue infection
-Consequence of diagnostic or therapeutic measures (injections)
-Penetrating damage by puncture or trauma

25

What investigations should be done for septic arthritis?

-FBC and differential (Raised WCC >12,000mm^3)
-ESR (>50 mm/hr)
-CRP
-Blood Cultures (+ve in 30-50%)
-Ultrasound (always be present)
-Synovial fluid (WCC>50,000mm^3, Gram stain, culture)

26

What presenting variables help to direct in diagnosis?

-Fever
-Ability to weight bear
-ESR
-CRP
-Serum WCC
-Joint space

27

How is septic arthritis treated?

-Aspiration
-Arthroscopy
-Arthrotomy
-IV antibiotics

28

What organism is the typical cause of septic arthritis?

Staph aureus

29

What is the epidemiology of osteomyelitis?

-Declining
-2-13/100,000 incidence
-Mean age 6 years (10 years for pelvic)

30

What risk factors are there for osteomyelitis?

-Blunt trauma
-Recent infection