Sunday, April 29, 2012

Paediatric Hip joint pain

Slipped capital femoral epiphysis : Obese adolescent male, referred pain to knee usually present, loss of abduction and internal rotation of hip. Tmt: surgical pinning promptly to avoid avascular necrosis.

Legg-Calve-Perthes disease:  child 4-10yrs, male, avascular necrosis of femoral head, idiopathic. Tmt- splint or surgery

Septic arthritisEmergency. Acute onset, warm swollen jt, hematogenous spread following URTI, staph & strep,
hip is externally rotated, X ray usually normal,  wbc count is high, ESR is high.
Do USS guided aspiration- synovial fluid leucocyte >100,000 is definitely SA, do culture.
Tmt : drain immediately, empirical antibiotics nafcillin (or vancomycin ) + cephalosporin

Avascular necrosis in sickle cell anemia: African descent, history suggestive of SS

Transient synovitismale child 3-10yrs, following trauma or viral infection.

Exclude septic arthritis. if at least 3 of the following are present, do further workup.

WBC >12,000,
ESR >40 ,
 Refusal to bear weight

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