Limp

Limp

transient synovitis (irritable hip)
1. commonest cause of acute hip pain in kids
2. 2-12 year olds
3. often follows or comes w/ viral infection
4. presentation
  1. sudden onset of pain in hip
    1. no pain @ rest
    2. pain may be referred to knee
  2. limp
  3. mild fever
  4. child appears well
5. needs differentiating from early septic arthritis of hip joint
  1. if SA suspected, must
    1. joint aspiration
    2. blood culture
6. can precede development of Perthes disease
7. Mx
  1. bed rest
  2. analgesia
  3. skin traction
    1. rarely
8. improves within a few days
Perthes disease
1. = avascular necrosis of capital femoral epiphysis of femoral head
  1. due to interruption of blood supply fb revascn & reossificatn over 18-36 months
2. mainly affects boys
  1. M:F= 5:1
3. insidious presentation
  1. onset of limp
  2. hip or knee pain
4. can be mistaken for transient synovitis
5. bilateral in 10-20%
6. Ix if ?Perthes disease
  1. X-ray both hips (incl frog views)
    1. early signs
      1. increased density in femoral head
        becoming fragmented & irreg
    2. if initial X-ray normal, repeat if sx continue
  2. bone scan & MRI
    1. may help diag
7. prognosis
  1. dependent on early diag
    1. if IDed early
      1. <1/2 femoral head is affected
        only bed rest & traction needed
  2. severe or late px
    1. femoral head must be covered by acetabulum
      1. to act as mould for reossifying epiphysis
      2. achieve by
        kip hip abducted
        plaster
        talipes
        femoral or pelvic osteotomy
  3. good in most kids
    1. esp < 6 years old & <1/2 epiphysis involved
    2. but older kids or more extensive involvement
      1. deformity of femoral head & metaphyseal damage more likely
        potential for subseq degenerative arthritis as adult
slipped capital femoral epiphysis (SCFE)
1. -> displacement of epiphysis of femoral head postero-inferiorly
  1. needs prompt Rx to prevent avascular necrosis
2. commonest @ 10-15 years old
  1. during adolescent growth spurt
    1. esp obese boys
3. bilateral in 20%
4. assoc w/ metabolic endocrine abnormalities
  1. hypothyroidism
  2. hypogonadism
5. presentation
  1. limp
  2. hip pain +/- referral to knee
  3. onset
    1. acute
    2. ff trauma
    3. insidious
6. O/E
  1. restricted abduction
  2. internal rotation of hip
7. Ix
  1. X-ray
    1. to confirm diag
    2. get a frog lateral view
8. Mx
  1. surgical
    1. pin fixation in situ

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	Erstellt von v.djabatey vor fast 11 Jahre