Cf Fm Ch 37 Limping In Children 2

Front 1

21. Common causes of limping in infants and toddlers?

Back 1

a. Septic arthritis
b. Fractures
c. Complications of congenital hip dysplasia

Front 2

22. Presentation of septic arthritis?

Back 2

a. It is usually monoarticular associated with systemic signs such as fever.
b. In young infants, the symptoms may be less obvious, such as crying, irritability, and poor feeding.
c. Children or ambulatory (crawlers or walkers) will often refuse to do anything that puts weight on the affected joint because of pain.
d. Infection of the joints causes a septic effusion, which raises the pressure of the joint capsule.

Front 3

23. How will children with a septic joint often lay?

Back 3

a. With their flexed, abducted, and externally rotated.
b. TThis helps to reduce the pain
c. They will have significant pain with any internal rotation or extension of the joint.

Front 4

24. Labs with a septic joint?

Back 4

a. ↑ ESR and CRP
b. ↑ WBC

Front 5

25. 2 Most commonly involved pathogens for a septic joint in younger infants (4 months or younger)?

Back 5

1. Group B Streptococcus
2. Staphylococcus aureus

Front 6

26. Most commonly involved pathogens for a septic joint in older infants and children under the age of 5?

Back 6

1. S aureus
2. Streptococcus Pyogenes

Front 7

27. Treatment of septic joint?

Back 7

a. Surgical irrigation and débridement
b. Along with antibiotics

Front 8

28. Common orthopedic causes of limp without pain (7)?

Back 8

1. Congenital developmental dislocation of hip
2. Spastic hemiplegia (cerebral palsy)
3. Legg-Calve-Perthes (subacute and chronic)
4. Leg length discrepancy
5. Proximal focal femoral dysplasia
6. Congenital short femur
7. Congenital bowing of the tibia

Front 9

29. Toddler’s fracture?

Back 9

a. A spiral fracture of the tibia that results from twisting while the foot is planted.
b. A spiral fracture is one example of an unsuspected fracture that may present primarily as a limp or a refusal to walk.
c. The diagnosis may be suspected in the setting of an acute limp or change in ambulation, a normal examination of the knee and upper leg and tenderness of the tibia.
d. It can be confirmed with a plain film x-rays

Front 10

30. Undiagnosed congenital dysplasia of the hip presentation?

Back 10

a. May present as a painless limp that is present from the time the child learns to walk.
b. All newborns and infants should have their hips examined for instability or dislocation

Front 11

31. Risk of undiagnosed congenital dysplasia of the hip?

Back 11

a. If undiagnosed, contractures may form that limit movement of the hip

Front 12

32. How do you confirm congenital dysplasia of the hip, diagnosis?

Back 12

a. X-rays showing abnormal hip alignment

Front 13

33. Treatment of congenital hip dysplasia?

Back 13

a. If found in the 1st few weeks of life, the child can be treated with splinting of the hip.
b. Normal development usually follows
c. If diagnosed late, the treatment is often surgical

Front 14

34. Aetiology and Pathophys of Transient synovitis (in young children)?

Back 14

a. Transient synovitis is a self-limited inflammatory response that is a common cause of hip pain in children.
b. Occurs typically in children ages 3 to 10 years
c. More common in boys than girls
d. Often follows a viral infection!!!!!!!!

Front 15

35. Presentation of transient synovitis?

Back 15

a. Is frequently seen as a gradually increasing hip pain that results in a limp for refusal to walk.
b. The children have a low grade or no fever
c. Normal WBC count
d. Normal ESR
e. On exam, there is pain with internal rotation of the hip and overall range of motion is limited by pain.
f. X-rays are either normal or show some nonspecific swelling

Front 16

36. Treatment of transient synovitis?

Back 16

a. In a situation where the patient is febrile, as pain-free rotation of the greater than 30°, has normal wbc count, normal ESR, and short-term follow-up can be assured, the patient can be followed clinically and should improve in a few days.
b. If these conditions are not met in the diagnosis of asepticum is considered, or the patient followed continues to worsen, and aspiration should be done.

Front 17

37. Characteristics of septic joint aspirate?

Back 17

a. Purulent aspirate
b. WBC >50,000

Front 18

38. Aspirate with transient Synovitis?

Back 18

a. Yellow/clear aspirate
b. WBC <10,000 (much lower than septic).

Front 19

39. Legg-Calvé-Perthes disease (LCP) aetiology/pathophys?

Back 19

a. LCP is an avascular necrosis of the femoral head that typically occurs in children ages 4 to 8 years.
b. It is much more common in boys than girls
c. Any disruption of blood flow to the femoral capital epiphysis, such as trauma or infection, may cause avascular necrosis.
d. In LCP disease, the Aetiology of the disruption of blood flow is unknown

Front 20

40. Presentation of Legg-Calvé-Perthes disease?

Back 20

a. Children typically have a gradual onset of hip, thigh, or knee pain, and limping over a few months.
b. Early in the course, x-rays of the hip may appear normal
c. Later radiographic findings include collapse, flattening, and widening of the femoral head.
d. Bone scan or MRI may be necessary to confirm the diagnosis.

Front 21

41. Treatment of Legg-Calvé-Perthes disease?

Back 21

a. Treatment is usually conservative!!!!!
b. With protection of the joint efforts to maintain range of motion
c. Children who develop more severe necrosis developed disease at older ages may have a worse outcome and a higher risk of developmental degenerative arthritis

Front 22

42. Capital femoral epiphysis?

Back 22

a. The capital femoral epiphysis is the growth plate that connects the metaphysis (femoral head) to the diaphysis (shaft of the femur)?

Front 23

43. Slipped Capital Femoral Epiphysis pathology?

Back 23

a. A slipped capital femoral epiphysis is a separation of the growth plate, which results in femoral head being medially and posteriorly displaced.
b. This may be caused by an acute injury, but more often is not.

Front 24

44. Typical patient presentation with Slipped Capital Femoral Epiphysis?

Back 24

a. Overweight adolescent boys and presents as pain in the hip, thigh, or knee, along with a limp.

Front 25

45. Physical exam for Slipped Capital Femoral Epiphysis reveals?

Back 25

a. Limited internal rotation!!!!
b. Obligate external rotation when it is passively flexed!!!!

Front 26

46. Radiographic findings for Slipped Capital Femoral Epiphysis

Back 26

a. Early x-rays may show a widening of the epiphysis
b. Later x-rays can show slippage of the femoral head in relation to the femoral neck.

Front 27

47. Treatment of Slipped Capital Femoral Epiphysis?

Back 27

a. Surgical pinning of the femoral head
b. These patients must be closely followed, is approximately 33% will develop avascular necrosis and 33% will develop SCFE of the contralateral hip.

Front 28

48. When should growing pains be considered as a diagnosis?

Back 28

a. Is a diagnosis of exclusion
b. It Should be considered if the pain is only at night, is bilateral, is not present during the day, and no other pathology is found.

Front 29

49. Complete

Back 29

49. Complete