Paediatrics: Locomotor Flashcards
What is the management of septic arthritis?
- Antibiotics
- IV following joint aspiration –> 4-6 weeks of PO
- Flucoxacillin or vancomycin (if pen allergic)
- Cefotaxine (if gonococcal) - Surgical drainage, lavage and debridement
- Splint (immobilise in functional position to reduce pain and swelling) –> Mobilisation (to prevent permanent deformity)
- Analgesia
- Physiotherapy - help stiffness
what are the common causative organisms for septic arthritis?
Staph. aureus (single joint) or Hib (multiple joints)
what is developmental dysplasia of the hip?
aka. congenital hip dislocation
occurs due to shallow acetabulum + joint laxity –> hip instability, subluxation, dislocation ± dysplasia
What are the causes of hip dyplasia?
- Joint laxity due to ^type 3 collagen or maternal oestrogen
- Decreased IU volume due to breech, oligohydramnios, first born
RF: Female, Left hip, Breech
What is the screening process for developmental dysplasia of hip?
Birth
- Barlow’s test - adduction and depression (+ve test is posterior dislocation)
- Ortolani test - abduction and elevation
(+ve test is relocation of femoral head into acetabulum)
- USS if +ve for both
8 weeks
- Uneven gluteal folds,
- Limited hip abduction
- one leg appears shorter
- Galazi sign (knees and hip flexed with feet together, shows one femur shorter than other)
if < 6 months –> USS
if > 6 months –> PA radiograph shows shallow acetabulum, hypo plastic femoral head
What is the management of hip dysplasia based on age?
< 6 months
- Pavlik harness - maintain hip in flexed position
6-18 months
- Manipulation, open or closed reduction with spica plaster cast
> 24 months
- may require surgery
What is the history of a child with developmental dysplasia?
- Delayed walking
- Recurrent falls
- Limp
- Talipes
- Older child also has reduced RoM during hip adduction, +ve trendelenburg gait, exaggerated lumbar lordosis
What is reactive arthritis?
Most common form of arthritis in children
A transient hero-negative inflammatory joint condition
What are the causes of reactive arthritis?
Post-infection typically:
- Gastroenteritis - salmonella, nshigella, campylobacter, versinia
- Chalamydia or Gonorrhoea
What are the symptoms of reactive arthritis?
Acute, sudden onset, often lasting < 6 weeks, no more than 12 months
- Oligoarthritis (less than 6 joints) - pain, hot, red, tender
- commonly lower back pain - Malaise, fatigue and mild fever
- Reiter’s syndrome - urethritis, conjunctivitis, arthritis
- Skin - erythema nodosum, circinate balanitis, dysmorphic nail changes
- mouth ulcers
What are the key investigations for reactive arthritis?
- Bloods - Raised ESR and cRP
- CXR normal
- stool, urine or throat swab for MSC to determine causative organism
What is the treatment for reactive arthritis?
- NSAIDS - diclofenac or ibuprofen (to reduce swelling and inflammation)
- Abx for specific cause
What is the most common cause of hip pain during childhood?
Transient synovitis i.e. irritable hip
what is the clinical presentation of transient synovitis?
- Hip pain - sudden onset, exacerbated by movement/weight bearing - no pain when not moved
- Limp
- Decreased range of movement - internal rotation
- No fever, malaise or systemic upset
What are the investigative findings of Perthes?
X-Ray (PA, lateral, frog) - widened joint space (early) flattening of femoral head and fragmentation (late)
