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Posts Tagged ‘children’s ortho’

The child with  a limp

A.  malignant primary bone tumour

B.  Perthe’s disease

C.  Septic arthritis

D. Developmental dysplasia of the hip

E.  Osgood -Schlatter’s  disease

F.  Slipped upper femoral  epiphysis

Match the following presentations with the most  likely diagnosis above:

1.  an overweight 13 year old boy with  a limp for 3 weeks

2.  a 14 year old boy with a warm hard mass above the knee

3.  a two year old with  painfree limp since starting to walk

4  a 6 year old boy with knee pain and a limp for  2 months

5  a 3 year old girl with a swollen knee and a fever with pain on weight bearing.

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We haven’t had much of a chance to  look at paediatric orthopaedic problems in the  lecture course so far so it might be useful to highlight some of these clinical problems now.

Top of the list to look at would be:

  • Developmental dysplasia of the hip (AKA congenital dislocated hip [CDH] or congenital hip dysplasia, Ed).  This may present as a clicking hip in a neonate or a limp or dipping hip  in a toddler.  Predisposing factors, clinical  features and management are (well) described in Master Medicine: Surgery, 3ed (2008) Lavelle-Jones & Dent in the library.
  • The next condition NOT TO MISS is infection – either osteitis or septic arthritis.  The differential diagnosis here is with transient synovitis and Perthe’s disease.
  • Finally two developmental  conditions in growing bones that also present with  a  limp in childhood are Slipped Upper (or Capital) Femoral Epiphysis (SUFE) and Osgood-Schlatter’s  disease (a name to conjure with? Ed)

I found this website from the American Academy of Orthopaedic Surgeons easy to  navigate and informative, but remember, you won’t need to know stacks about these conditions.

http://orthoinfo.aaos.org/menus/children.cfm

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