Children’s Orthopaedics – The Limping Child Flashcards
What is a limp defined as?
An abnormal gait commonly due to pain, weakness or deformity
What are some different types of gait abnormality? Brief descriptions of each
Antalgic gait - gait that develops as a way to avoid pain
Trendelenburg gait - develops due to proximal muscle weakness
Toe walk - develops due to a limb being short on one side
Adducted limb w loss of rotation - develops from joint stiffness
What are some of the most common causes of limping in children under the age of 5?
- May be normal variant (neuro system still developing)
- Trauma (may have fallen w/out supervision)
- Transient / toxic (post-infective) synovitis
- Osteomyelitis
- Septic arthritis
- DDH
- JIA
What are some of the most common causes of limping in children from the ages of 5-10?
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- Perthes disease
What are some of the most common causes of limping in children from the ages of 10-15?
- Trauma
- Osteomyelitis
- Septic arthritis
- SUFE
- Chondromalacia
- Neoplasm
What is morning pain a sign of? What can be a common sign of underlying skeletal dysplasia / systemic inflammation?
- Morning pain suggests an inflammatory component (JIA?)
- Bilateral symptoms can suggest systemic inflammation / underlying skeletal pathology
What is an important difference between taking a history from a young child versus an adolescent?
Often have to rely on parent for history of presenting complaint in younger children
As child gets older need to take history from child themselves
What is Gower’s sign? In the case of a positive Gower’s test what would be the next step?
- When the child is getting up from the floor they need to place their hands onto their knees to help them get up
- If positive proceed to test creatine kinase, as muscular dystrophy is possible
When trying to differentiate between transient synovitis, osteomyelitis and septic arthritis what signs can be important?
- Will the child weight bear (won’t in septic arthritis, may be painful in osteomyelitis)
- Systemic wellness
- History of infection?
- Pattern / timing of pain
Investigations for limping child when diagnosis is in question?
Bloods: ESR & CRP, WCC, CK, cultures
- Temperature
- X-Ray
What factors make up the Kocher criteria for determining the likelihood of septic arthritis?
- Pyrexia
- Can the child weight bear?
- WBC
- ESR
(nowadays also include CRP)
What are the cardinal signs of septic arthritis? Which joints are most commonly affected?
- Child will be in pain and will resist moving & weight bearing. (redness / swelling is a late sign)
Knee > Hip»_space; ankle > shoulder
Common routes of entry for infection precipitating septic arthritis?
- Haematological spread
- Dissemination from osteomyelitis
- Adjacent infection (eg cellulitis)
- Puncture wounds
Treatment of septic arthritis?
- Aspirate the joint (may require arthroscopy depending on joint)
- Antibiotics (often requires intense course, 2 weeks IV followed by 4 weeks oral)
What can be a very similarly presenting differential diagnosis for septic arthritis?
Osteomyelitis
