ORTHOPAEDICS - PAEDIATRICS

ResponseSCFE = SCFE
Tumour - sarcoma
Overuse syndrome
Lower back problems
Osgood schlater(tibial tuberosity)/Sever's (Calcaneus) disease

ResponseInfection

• TB, EBV, CMV, HIV, Chronic OM, Toxoplasmosis, syphilis

Inflammatory

• Juvenile RA, SLE, Sarcoid

Neoplastic

• Lymphoma (Hodgkin/non hodgkin), Neuroblastoma, ALL/AAML, Rhabdomyosarcoma, Ewing sarcoma, neuroblastoma

Other

• Drug related eg: Phenytoin

ResponseDuration of symptoms (>7 days concerning)
History of trauma, falls or injury
Location and severity of pain - Severe localised joint pain suspicious for septic arthritis
Change to urinary or bowel habit
Functional limitations - complete inability to walk/weightbear = significant pathology
Nocturnal pain or symptoms
Systemic symptoms -f eve, night seats, chills, rigors, rash
Constitutional symptoms, unplanned weight loss, lethargy, anorexia = suspicious for Malignancy/haematologic
Recent viral infection - transient myositis

ResponseFever
Generalised wasting, pallor
Interaction with carer ? NAI
Assess gait - able to walk +/- Run
Joint examination and movement - marked reduction mroe suggestive of serious pathology
Neurologic assessment of affected limb
Vascular assessment of affected limb
Abdomen/scrotal/back/spine examination
Petechiae/purpura/echymosis - ?HSP/Malignancy/haematologic cause

ResponseFracture - Accidental and NAI - toddlers fracture - tender tibia on palpation of shaft, history of fall
NAI - multiple bruises of different ages, inconsistent history from parent
Septic Arthrritis - fever, pain on passive ROM
Other infection - psoas abscess, osteomyelitis
Foreign body in foot - FB visible on inspection
Transient synovitis - history of viral illness, well child
Juvenile arthritis
Perthes

ResponsePerthe’s disease - XR loss of femoral head height, fragmented epiphysis
SCFE - XR slipped femoral head, trethoan’s sign
Septic arthritis - Fever, raised inflammatory markers, loss of ROM, Kocher’s criteria
Transient synovitis - Child well, recent viral illness
Fracture - seen on xrays, history of trauma
Haematologic (eg: Lukaemia) - Lukaemia blood flim, raised WCC, Blasts

ResponseXR hip - Exclude fracture ?DDH, Perthes (femoral head distruction)
US hip joint - Effusion in septic hip

• Aspirate of hip effusion if positive for cell count interpretation + Culture

FBC - Cell lines ? bone marrow process
CRP/ESR - inflammatory markes - elevated in septic joint
Blood culture - slow but useful if SA
Bone scan or MRI - difficult but plausible

ResponseSeptic arthritis excluded
Parenteral satisfaction with management and plan
Clear discharge and follow up plan
Child not requiring admission for any further therapy or investigation
Time of day and transport consideration
Social concerns addressed, ability to return if change in condition

ResponseFever
Refusal to weight bear
WCC >12
ESR >40 (CRP >20)

0 = very low, 1= low risk ~3%. 2 = 4%, >=2 scores ortho referral. 3 = 93%, 4 = 99%

ResponseS. Aureus
MRSA
Streptococcus Sp. (GBS - neonates, GAS - infants + children)
Gram negative bacilli
HiB - neonates
Kingella kingae - infant/preschoolers
Neisseria Gonorrhoeae - Sexually active adolesents

ResponseFlucloxacillin 50 mg/kg IV QID
If <4 years old - Cefazolin 50 mg/kg IV TDS (higher risk of Kingella Kingae)

• RCH OM or SA Antibiotics