Limping Child

Question 1

Basic motor milestones

Answer 1

Crawl: 8-9M
Walk 12-18M
Run 1.5-2 years
Kick a ball : 2-2.5Y
Ride tricycle: 3Y
Hop on 1 foot 4 Y
Climbs stairs adult fashion 5Y

Question 2

What are the most common causes of developmental delay?

Answer 2

CP
1o miscle disorders
Global developmental delay

Question 3

What are some pathological gaits in children?

Answer 3

1. Trendelenburg (waddling gait)- abductor weakness- drifting of hip to other side-> has to make leg circle to go round.
   Causes: developmental dysplesia, Legg calve.
2. Antalgic gait- adopted because of hip pain- leans on affected side, short steps and longer on other side: infx, trauma, slipped femoral epiphysis.
3. Ataxic gait- wide based- loss of proprioception due to cerebellar fx eg ataxic cp
4. Foot drop-> diff w/ foot dorsiflexion- knee raised high to fit- CP peroneal miscle atrophy.
5. Spastic gait: stiff legs with unbalanced coordination. Due to CNS lesions eg CP.

Question 4

DDx of limping

Answer 4

Developmental dysplesia of Hip DDH
Trauma: fractures, sprain, contusion
Infx: osteomyelitis, septic arthritis,
Neuroplastic: CP, Males, duchennes)
Rheumatological disorder

Question 5

Hx???

Answer 5

1. How long eg acute?
2. Any trauma?
3. Wt bear- eg not bearing in Septic Arthitis
4. Pain, any other joints?

Referred pain??
Septic- immediate management

Question 6

What happens in SA?

Answer 6

Affects hip joint in kids, and knees in older childern.

Majority

Question 7

Common organisms for SA?

Answer 7

Staph aureus, Haemophilus influenzae, group B strep.

IV antibioticcs should be started immediately after joint aspiration. As joint destruction very rapid. Can lead to permanent fx loss.

Question 8

2 tests to see if congenital hip probs?

Answer 8

Barlows tets

Ortolani .
Typical finding: decreased internal rotation

Question 9

What else is assc with avascular necrosis?

Answer 9

Legg-Calve-Perther D

Idiopathic avascular necrosis of capital femoral epiphysis