PAEDIATRICS EDITION: HIGH YIELD LIMPING CHILD FOR FINALS!

Introduction

In this tutorial, we will explore the key concepts and conditions associated with limping in children, particularly focusing on high-yield topics for medical finals. Understanding these conditions is crucial for diagnosing and managing pediatric patients effectively. We will cover developmental dysplasia of the hip, Perthes disease, septic arthritis, transient arthritis, and slipped upper femoral epiphysis.

Step 1: Understand Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) is a condition where the hip joint is improperly formed. Here’s how to recognize and manage it:

• Signs and Symptoms

  • Asymmetrical skin folds on the thighs
  • Limited range of motion in one hip
  • Positive Ortolani or Barlow test

• Management

  • Early detection is key; refer to a pediatric orthopedist.
  • Use of a Pavlik harness for infants to maintain hip position.

Step 2: Identify Perthes Disease

Perthes disease involves the avascular necrosis of the femoral head and can result in limping.

• Signs and Symptoms

  • Gradual onset of hip pain
  • Limping, particularly after activity
  • Limited internal rotation of the hip

• Management

  • Refer to a specialist for imaging (X-rays or MRI).
  • Treatment may include rest, physical therapy, or surgery in severe cases.

Step 3: Recognize Septic Arthritis

Septic arthritis is an emergency condition caused by infection in the joint, requiring immediate attention.

• Signs and Symptoms

  • Sudden onset of severe joint pain
  • Swelling and warmth over the affected joint
  • Fever and systemic signs of infection

• Management

  • Conduct a thorough history and physical examination.
  • Obtain joint aspiration for analysis and culture.
  • Administer antibiotics and consider surgical intervention if necessary.

Step 4: Differentiate Transient Synovitis

Transient arthritis, often seen in children, typically follows viral infections.

• Signs and Symptoms

  • Sudden hip pain often after a viral illness
  • Limping with a willingness to bear weight
  • Normal blood markers with a mild effusion seen on ultrasound

• Management

  • Rest and NSAIDs for pain management.
  • Monitor and reassure parents; most cases resolve spontaneously.

Step 5: Assess Slipped Upper Femoral Epiphysis

This condition is characterized by slippage of the femoral head at the growth plate.

• Signs and Symptoms

  • Chronic hip or knee pain
  • Limited internal rotation of the hip
  • Often occurs in overweight adolescents

• Management

  • Immediate referral to orthopedics is crucial.
  • Surgical fixation is often required to prevent further slippage.

Conclusion

Understanding the various causes of limping in children is essential for effective assessment and management. Key conditions include developmental dysplasia of the hip, Perthes disease, septic arthritis, transient arthritis, and slipped upper femoral epiphysis. Remember to conduct thorough assessments and refer to specialists when necessary. Staying updated on these conditions will enhance your clinical skills and readiness for finals.