the limping child

Question 1

stance phase

Answer 1

weight bearing

heel strike-> plantar flex -> toe-off

Question 2

swing phase

Answer 2

toe-off -> heel strike

rotation and tilting of pelvis and stability of lumbar spine and abdomen

Question 3

antalgic gait

Answer 3

usually from pain, less time in stance phase

Question 4

trendelenburg gait

Answer 4

stance phase body sway away from weak hip abductor and swing phase droop of the weak side

Question 5

waddling gait

Answer 5

seen in b/l hip involvement or neurological dz

Question 6

stiff-legged gati

Answer 6

knee extension and circumduction w/pelvic elevation on affected side

Question 7

toe-walking

Answer 7

habitual or due to mm contractures, spasticity or puncture

Question 8

steppage

Answer 8

difficulties w/dorsiflexion of foot

assocaited with peroneal neuropathies

Question 9

stooped

Answer 9

might indicate abdominal pathology

Question 10

generalized mm weakness

Answer 10

from muscular dystrophy or metabolic cause

Question 11

0-4 developmental Ddx

Answer 11

hip dysplasia

Question 12

0-4 trauma Ddx

Answer 12

toddlers fracture
physeal fracture 
puncture wound
sprain
contusion

Question 13

0-4 infectious ddx

Answer 13

osteomyelitis
septic arthritis
transient/toxic synovitis
discitis

Question 14

4-10 trauma ddx

Answer 14

physeal fracture
puncture wound
sprain
contusion

Question 15

4-10 infectious ddx

Answer 15

transient/toxic synovitis
septic arthritis
osteomyelitis

Question 16

4-10 other ddx

Answer 16

legg-calve-perthes disease
leukemia
JIA

Question 17

10-18 trauma ddx

Answer 17

slipped capital
femoral epiphysis
fractrue
sprain
contusion

Question 18

10-18 infectious ddx

Answer 18

osteomyelitis
septic arthritis
lyme disease
gonoccal arthritis

Question 19

10-18 other ddx

Answer 19

stress fractures

Question 20

developmental hip dysplasia

Answer 20

0-4
abnormal formation of hip joint
unknown cause
5-9x more common in female 
can often see other ortho problems

Question 21

risk factors for hip dysplasia

Answer 21

female
breech
nulliparous
oligohydraminos

Question 22

barlow

Answer 22

press down to dislocate hip

Question 23

ortolani

Answer 23

press up to relocate hip

Question 24

toddlers fracture

Answer 24

spiral fracture of tibia <5yrs old
often difficult to see on x-ray
sx: pain, refusal to walk, minor swelling/warmth, pain with palpation
Tx: cast

Question 25

physeal gracute

Answer 25

``` girls 0-16, boys 0-18 weakest are of growing bone 15% of all childhood fractures B>G salter harris fracture ```

Question 26

stress fracture

Answer 26

``` small crack in bone often from overuse/high impact sports weight bearing bones 2nd/3rd meta most common 10-18 ```

Question 27

Sx and Tx of stress fracture

Answer 27

pain that increases with weight bearing, tender to touch | Tx- rest

Question 28

osteomyelitis

Answer 28

inflammation of bone marrow and adjacent bone all ages children via hematogenous spread usually in metaphysis of long bones

Question 29

Sx and Tx of osteomyelitis

Answer 29

``` local inflammation fever bone tenderness decreased ROM Tx IV abx for 4-6wks ```

Question 30

most common inciting agent in osteomyelitis

Answer 30

S. aureus

Question 31

septic arthritis

Answer 31

infection w/the joint space all ages bacterial, viral, fungal, parasite intense synovitis is result of inflammatory response

Question 32

Sx and Tx of septic arthritis

Answer 32

monoarticualr erythema, swelling, pain, decreased ROM knee most common Tx IV/PO abx

Question 33

transient/toxic synovitis

Answer 33

``` aka irritable hip syndrome acute hip pain, decreased ROM hip in flexion/abduction and ext rotation age 0-10 yrs Dx of exclusion unknown cause self limited, NSAIDS ```

Question 34

legg-calve-perthes disease (LPC)

Answer 34

aka idiopathic osteonecrosis of femoral head 4-10 B>G typically thin, active boys

Question 35

Sx and Tx of LPC

Answer 35

slight limp, pain in knee, thigh, or groin limited ROM leg length discrepancy meds/reduce activity, immobilization not good anymore

Question 36

slipped capital femoral epiphysis (SCFE)

Answer 36

noninflammatory condition, femoral head displaced from femoral neck can begin as u/l but most become b/l typically overweight boys assocaited with endocrine disorders (primary hypothryoid and HGH deficiency)

Question 37

Sx and Tx of SCFE

Answer 37

insidious, complaint of pain in hip and limp | Tx surgical stabilization- pin

Question 38

JIA

Answer 38

chronic pain for min of 6wks <16 joint effusion, pain, limited ROM, warmth, worse in am unknown cause

Question 39

growing pains

Answer 39

intermittent nonarticular pains in childhood dx of exclusion Sx: typically pain at night and limited to calf, thigh, or shin pain is short live resolved with heat, massage, or mild pain killers pain free during day unknown cause