We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byFaith Pickle
Modified over 2 years ago
Evaluation of the Child with a Limp DD Aronsson University of Vermont
Hx – 2-year-old boy limps because of pain in the right thigh (antalgic) PE – pain and swelling just above the knee
Differential Diagnosis Bone infection (osteomyelitis) Joint infection (septic arthritis) Fracture Toxic synovitis
Bone & Joint Infections Hematogenous origin – Strep throat Implantation – Stepping on a nail
Osteomyelitis Metaphyseal origin Vessels don’t cross the growth plate
Septic Arthritis Infection can decompress into a joint Septic dislocation
Clinical Findings Systemically ill Irritable Refusal to bear weight Pseudoparalysis Pain & swelling @ the site
Laboratory Studies Elevated WBC,ESR, & CRP 50% Positive blood culture Infant – May be normal
Imaging Radiographs – Soft tissue swelling Bone scan – Increased uptake
Treatment Aspiration is the “key” to the diagnosis Don’t wait for imaging Subperiosteal aspiration
Treatment IV antibiotics – S aureus, gram-negative enteric, & Group B Streptococcus Surgical decompression – Hip & shoulder
Hx – 18 month-old girl limps on the left leg (no pain) PE – short left lower extremity is causing the limp
Differential Diagnosis Developmental dysplasia of the hip Limb-length discrepancy
DDH Instability Subluxation Dislocatable Reducible dislocation Irreducible dislocation
Etiology Unknown Multifactorial Geneticwhites Physiologicgirls Mechanicalbreech Environmentalswaddling
Barlow Provocative Test Dislocates hip (exit) Clunk
Ortolani Maneuver Reduces dislocated hip (entry) Abduction Clunk
PE > 3 Months 57º 43º Limited abduction is key
PE > 3 Months Asymmetric thigh folds – Limb-length discrepancy
Ultrasound Alpha > 60º – Slope of osseus acetabulum
Pavlik Harness Success Dysplasia 95% Dislocated 80%
Hx – 6-year-old boy limps on the right leg PE – limp with painful range-of-motion of the hip
Differential Diagnosis Infection Toxic synovitis Slipped capital femoral epiphysis (endocrine) Legg-Calv -Perthes disease
Legg-Calv -Perthes Loss of blood supply of the epiphysis
Legg-Calv -Perthes History – Pain in the groin or knee – Limp – Aggravated by exercise
Legg-Calv -Perthes Physical examination – Decreased internal rotation – Decreased abduction – Irritable hip
Necrotic stageFragmentation stage
Reossification stageRemodeling stage
Treatment Containment – Physical therapy ROM exercises – Orthosis Abduction & internal rotation – Osteotomy
Toxic synovitis History – sudden onset – Pain in groin or thigh – Painful limp – URI 2 weeks ago
Physical Examination Limp Irritable hip with guarding Mimic septic hip
Treatment Activity modification Expect improvement Question diagnosis if not responding
Hx – 14-year-old obese boy has pain in the right knee and limps PE – no swelling and full ROM of the knee but decreased internal rotation of the hip
Differential Diagnosis Infection Osgood-Schlatter disease Anterior knee pain Slipped capital femoral epiphysis
Slipped Capital Femoral Epiphysis (SCFE) Most common hip disorder in adolescents Age – Boys 14 y/o – Girls 12 y/o
Etiology Endocrine – Hypothyroid – Growth hormone treatment Mechanical – 63% > 95th percentile weight
Hip Flexion Causes Abduction & External Rotation FABER
AP Pelvis Radiograph Wide & irregular physis Epiphysis at or below Klein’s line Klein’s line
Frog Pelvis Radiograph Posterior slip Wide, irregular physis
Preop AP pelvisPreop frog pelvis
Postop AP pelvisPostop frog pelvis
Limp Think hips
DIAGNOSIS OF SEPTIC JOINT IN CHILDREN Sara Jane Shippee UW Orthopaedic Surgery, PGY-1 Seattle Children’s Hospital 11/1/2012.
Common Pediatric Hip Problem Dr. Abdulmonem Alsiddiky, MD, SSCO Associate professor & consultant Pediatric Orthopedic & Spinal Deformities.
James Pegrum (Peggers) MB BS BSc MSc (SEM) MRCS (Eng) Diploma in MM (UIAA)
Slipped capital femoral epiphysis (SCFE). SCFE Posterior and Medial displacement of the femoral capital epiphysis on the femoral neck through sudden.
Approach to Limb Pain in Children/Osteomyelitis
Common Hip Disorders In Children Dr.Kholoud Al-Zain Assistant Prof. Ped. Orthopedic Consultant April 2012 (Acknowledgment to 5 th cycle students 2010)
Dr. FATEMA AL TAMIMI Pediatric rheumatology consultant.
Prof. Mamoun Kremli AlMaarefa College
Pediatric Orthopedic Diseases. Categories Congenital Developmental Neuromuscular Metabolic Acquired : inflammatory infection trauma tumor.
The Limping Child AAPA. Definition Limp = Asymmetry Joint - Range of motion Bone - Deformity Pain Control.
Pediatric Lower Extremity Orthopedic Concerns
Nontraumatic Orthopedic Emergencies. Objectives Understand the pathophysiology of nontraumatic orthopedic conditions. Describe the management of nontraumatic.
Legg- Calve – Perthes disease. Anatomy Acetabular retroversion.
Myra Lalas Pitt Morning Report 9/12/11
Disease and Injury of the Hip By Ly Nguyen & Hayley Lough.
CDH Congenital Dislocation of the Hip
Slipped Capital Femoral Epiphysis SCFE
Common Pediatric Hip Problem
Paediatric Orthopaedics E.E.Fogarty F.R.C.S.I, F.R.A.C.S.
The Limping Child Christopher M. Prior, DO MAJ, MC, USA Primary Care Sports Medicine.
TRIPLE PELVIC OSTEOTOMY FOR THE TREATMENT OF HIP DYSPLASIA.
Pyogenic Bone and Joint Infection Abdulaziz Al-Ahaideb FRCSC.
Legg Calve Perthes Disease
CDH CONGENITAL DISLOCATION OF THE HIP
Allison Eliscu, MD, FAAP Rev. Aug What is SCFE? Salter Harris I fracture through proximal femoral epiphysis Displacement of femur distal to physis.
March 22, Most common organism? Staph Aureus Presentation? Acute Monoarthritis Erythema Warmth Swelling Intense pain.
1 Pediatric Orthopedics Rounds Nov 2002 Abdulaziz Al-Ahaideb.
Common Pediatric Orthopaedic Problems
Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.
Common Hip Disorders In Children
Evaluation of the Child with Acute Limp Bruce Minnes MD, FRCPC Staff Physician and Assistant Professor, Division of Paediatric Emergency Medicine Chief.
X-Ray Rounds Cass Djurfors Feb 20, y.o. boy with leg pain Obese 10-year old male presents with a two week history of right thigh and knee pain.
CASE CONFERENCE Qadeer Ahmed PEM Fellow 03/05/2015.
2/11/2016 Jenelle Beadle Developmental Dysplasia of the Hip.
DEVELOPMENTAL DYSPLASIA OF THE HIP
Vanderbilt Sports Medicine SEACSM Clinical Conference Hip Pain while Playing Hoops Doug Connor, MD Pediatric Sports Medicine Fellow Vanderbilt University.
Unusual Complication in a septic hip Jong Sup Shim Samsung Medical Center Sungkyunkwan University School of Medicine.
A Limping Child Laura Cuthbert. Overview An unusual presentation Key learning points Differential diagnosis Some specific examples Case discussion.
Evaluation of a Painful Total Knee Arthroplasty Sarat Kunapuli, DO EASTERN OKLAHOMA ORTHOPEDIC CENTER.
Hip Pathology for General Practice
Lower Extremities Third Part Dr Mohamed El Safwany, MD.
David C Koronkiewicz, D.O. IU Goshen Orthopedics and Sports Medicine
Orthopedics Disorders Pediatrics Part II Jan Bazner-Chandler RN, MSN, CNS, CPNP.
Thigh and knee pain in an obese 10 year old Pediatric Case Presentation By Annerie Hattingh 28 October 2009.
Approach to limping child
MUSCULOSKELETAL DISORDERS THE MUSCULOSKELETAL SYSTEM Bones and bone growth –Epiphyseal plates…bone growth occurs here and when these seal over, there.
TULSA BONE & JOINT CHAPTER 24 SPECIAL CONCERNS OF THE PEDIATRIC PATIENT ROTATIONAL DEFORMITIES Intoeing – “pigeon toed”, common. Usually spontaneously.
© 2017 SlidePlayer.com Inc. All rights reserved.