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MSK > The Acute Limping Child > Flashcards

The Acute Limping Child Flashcards

1
Q

Causes of limp in 0-3 years old

A 
septic arthritis 
osteomyelitis
toddler's fracture
DDH
NAI
soft tissue injury
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2
Q

What does NAI stand for?

A

Non-accidental injury

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3
Q

Causes of limp in 3-10 years old

A

Trauma - bone/ST
Septic arthritis
Perthes disease
Transient synovitis

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4
Q

Causes of limp in 11-15 years old

A 
Trauma - stress
Septic arthritis 
osteomyelitis 
SUFE
Perthes
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5
Q

Causes of limp in children

A 
septic arthritis
osteomyelitis 
Perthes
SUFE
Toddler's fracture
Soft tissue injury 
NAI 
Tumour
endocrinopathies 
sickle cell 
ST/spine infection 
metabolic disease 
neoplastic 
anatomical 
rheumatological 
neuromuscular
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6
Q

What does SCFE/SUFE stand for?

A

Slipped upper/capital femoral epiphysis

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7
Q

Pathology of SCFE/SUFE

A

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

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8
Q

What age range can get SUFE/SCFE?

A

9-16 years; so older children

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9
Q

What gender mostly gets SUFE/SCFE?

A

M > F, 60:40

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10
Q

Causes of SUFE/SCFE

A 
Idiopathic
- adolescence 
- delayed bone age
- increased weight 
Secondary to underlying disorder
- hypothyroidism 
- hypogonadism 
- renal osteodystrophy 
- growth hormone therapy
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11
Q

What does SUFE/SCFE have a relation to?

A

Obesity

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12
Q

Presentation of SUFE/SCFE

A 
Pain - groin/thigh/knee
Limp 
Trauma
ER deformity + on flexion + on gait (externally rotated extremity)
ROM limited by pain
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13
Q

Treatment of SUFE/SCFE

A

Percutaneous screw fixation

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14
Q

Who is SUFE/SCFE most commonly seen in?

A

Adolescent obese males

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15
Q

A presenting history which would flag a concern or would help to exclude it would include;

A 
limp (age dependent)
pain 
general malaise/loss of apetite/listless 
Temperature 
Recent UTI/ear infections
trauma
pseudoparalysis
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16
Q

Presentation of septic arthritis in children

A 
Limping
ability to weight bear
pseudoparalysis
swollen, red joint
refusal to move joint 
pain 
temperature
17
Q

Routes of infection of septic arthritis

A 
Haematogenous
Dissemination of osteomyelitis 
Spread from adjacent soft tissue infections
diagnostic or therapeutic measures
penetrating damage by puncture of trauma
18
Q

investigations of septic arthritis in children

A 
FBC + differential - WCC > 12,000
ESR > 50 
CRP 
Blood cultures (+ve 30-50%)
Xray 
USS
Synovial fluid (WCC > 50,000, gram stain, culture)
19
Q

Treatment of septic arthritis

A

Aspiration
Arthroscopy
Arthrotomy
Antibiotics

20
Q

Mean age of osteomyelitis in children

A

6 y/o

10 y/o pelvis

21
Q

Risk factors for osteomyelitis

A

blunt trauma

recent infection

22
Q

Presentation of osteomyelitis

A 
pain 
localised signs/symptoms
fever
reduced ROM
reduced weight bearing
23
Q

Investigations of osteomyelitis

A 
radiography
Tc99 bone scan 
MRI
CT 
USS
24
Q

Most common site of osteomyelitis in children

A

femur

25
Q

Treatment of osteomyelitis

A

Antibiotics

Surgery

26
Q

Presentation of transient synovitis in children

A 
NOT THAT UNWELL
limping 
often touch weight bearing 
history of viral infection - UTI/ear
Apyrexial - no fever
low CRP
Normal WCC 
May have joint effusion
27
Q

Definition of arthalgia

A

joint pain

28
Q

What is transient synovitis?

A

Transient inflammation of the synovium of the hip causing arthalgia and arthritis. Most common cause of acute hip pain in children aged 3-10 years

29
Q

3 factors of the pathogenesis of Albright osteodystrophy

A
  1. vascular anatomy
    - vascular loops, terminal branches
  2. cellular anatomy
    - inhibited phagocytosis (low PO2)
  3. Trauma
30
Q

Features that raise concern of neoplasm

A 
night pain 
often incidental trauma
stop doing sport/going out
sweats and fatigue 
Abnormal blood results 
- low Hb, atypical blood film, atypical platelets
31
Q

Where does Perthes Disease affect?

A

The hip

32
Q

Pathology of perthes disease

A

occurs when blood supply to the rounded head of the femur is temporarily disrupted and this leads to a vascular necrosis, where the bone cells die

33
Q

Presentation of perthes disease

A 
Pain 
- in hip or groin 
- referred to thigh or knee 
- worsens with activity 
- relieved by rest 
painful muscle spasms
34
Q

Treatment of perthes disease

A 
observation 
anti-inflammatory mediators
limiting activity 
physio 	
casting and bracing 
possibly surgery

MSK (25 decks)

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