Children’s Orthopaedics - The Limping Child

Question 1

Limp?

Answer 1

Abnormal gait usually due to pain, weakness or deformity

Question 2

If a limping child is in pain, which type of gait do they tend to have?

Answer 2

Antalgic gait

->maybe think similar to analgesics which are pain meds??

Question 3

If a limping child is in weakness, which type of gait do they tend to have?

Answer 3

Trendelenburg gait

Question 4

If a limping child has a shorter limb, which type of gait do they tend to have?

Answer 4

Toe walk

Question 5

If a limping child has a stiff joint, which type of gait do they tend to have?

Answer 5

Adducted gait and loss of rotation

Question 6

Most likely causes of a limping child are broken into groups depending on age.
List some of the more likely causes of a limping child aged 0-5yrs.

Answer 6

Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
Developmental dysplasia of the hip
Juvenile idiopathic arthritis

Question 7

Most likely causes of a limping child are broken into groups depending on age.
List some of the more likely causes of a limping child aged 5-10yrs.

Answer 7

Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
Perthes disease

Question 8

Most likely causes of a limping child are broken into groups depending on age.
List some of the more likely causes of a limping child aged 10-15yrs.

Answer 8

Trauma
Osteomyelitis
Septic arthritis
SUFE (slipped upper femoral epiphysis)
Chondromalacia
Neoplasm

Question 9

When in the day are rheumatic conditions the worst?

Answer 9

Worst in the morning and get better as the day goes on

Question 10

A child that is unable to weight bare is unusual. What will often need to be done as a follow up?

Answer 10

An appropriate investigation

Question 11

What is elevated in the blood in muscle dystrophy?

Answer 11

Creatinine kinase

Question 12

Management of septic arthritis?

Answer 12

Immediate drainage and antibiotics

Question 13

Transient synovitis?

Answer 13

Post-viral infection of the joints

Question 14

Which criteria can be used to predict how likely a patient is to have sepetic arthritis.
There are four criteria, the more the patient has, the more likely they have to have septic arthritis.
For example, a score of 1 = <3% chance they have it
Score of 2 = 40%
Score of 3 = 93% chance
Score of 4 = 99.6%

Don’t get bogged down by the numbers, this is just to show how much these criteria help with diagnosis.

Okay, so what are the four criteria?

Answer 14

Pyrexia (>38 degrees)
Unable to weight bear
WBC >12,000/ml
ESR >40mm/hr

Question 15

What is a high ESR indicative of?

Answer 15

Inflammaion

Question 16

RECAP- septic arthritis presentation?

Answer 16

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

Question 17

Commonest sites for septic arthritis?

Answer 17

Knee
Hip
Sacroiliac joint in older children and young adults

Question 18

RECAP- route of entry for septic arthritis?

Answer 18

Infection from removed tooth
Spread from adjacent infected tissue
Dissemination from osteomyelitis

Question 19

RECAP- which microorganism is the most common cause of septic arthritis?

Answer 19

Straph. Aurues

Question 20

What are some of the red flag symptoms in children?

Answer 20

Sweats
Fever, particularly at night
Abnormal blood tests

->all indicative of serious underlying disease e.g. malignancy