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2508257382510SUFESalter Harris I00SUFESalter Harris I43770558926829Epidemiology: early adolescence (older than Perthes); often overweight, male; may be associated with hypothyroidism, often bilateral; jostrpy of injury in <30%; mean age 12 in girls, 13 in boysExamination: external rotation and shortening; especially internal rotation sore +/- flexion and abduction00Epidemiology: early adolescence (older than Perthes); often overweight, male; may be associated with hypothyroidism, often bilateral; jostrpy of injury in <30%; mean age 12 in girls, 13 in boysExamination: external rotation and shortening; especially internal rotation sore +/- flexion and abduction4460240737997000154813073825102413005483860Investigation00Investigation15481305484495USS: high sensitivity; can’t tell cause of effusion; can guide joint aspirationXR: image whole limb; shows fracture, soft tissue signs, osteomyelitis / septic arthritis bony destruction (after 10-14/7), tumour, asceptic necrosis, SUFETechnetium bone scan: 85 – 100% sensitivity, 70 -95% specificity for osteomyelitis within 48-72hrs; also detects Perthes, osteoma, stress fracture; may need to repeat at 3/7Bloods: ESR (>50-70 in 80-90% septic arthritis / osteomyelitis; >20 in transient synovitis); CRP (>12 in septic arthritis); WCC (>20 in osteomyelitis / septic arthritis; L shift); blood cultures (+ive in 60% septic arthritis; usually Staph aureus)Arthrocentesis: culture +ive in 60% septic arthritis Septic arthritis WCC 10 – 100,000; neuts >75%; ? glucpseOther: MRI (avascular necrosis), RF, ANA, complement, uric acid00USS: high sensitivity; can’t tell cause of effusion; can guide joint aspirationXR: image whole limb; shows fracture, soft tissue signs, osteomyelitis / septic arthritis bony destruction (after 10-14/7), tumour, asceptic necrosis, SUFETechnetium bone scan: 85 – 100% sensitivity, 70 -95% specificity for osteomyelitis within 48-72hrs; also detects Perthes, osteoma, stress fracture; may need to repeat at 3/7Bloods: ESR (>50-70 in 80-90% septic arthritis / osteomyelitis; >20 in transient synovitis); CRP (>12 in septic arthritis); WCC (>20 in osteomyelitis / septic arthritis; L shift); blood cultures (+ive in 60% septic arthritis; usually Staph aureus)Arthrocentesis: culture +ive in 60% septic arthritis Septic arthritis WCC 10 – 100,000; neuts >75%; ? glucpseOther: MRI (avascular necrosis), RF, ANA, complement, uric acid2413004500245Assessment00Assessment15481304498975History: trauma, fever, systemic illness (viral illness, bacterial focus; fever, anaemia, malaise, weight loss, loss of appetite), acute / chronic, PMH (diabetes, sickle cell, haemophilia), pain (early morning stiffness = rheumatoid arthritis, nocturnal = bone neoplasm); drug history; NAI Examination: fever (>38.5° in 70% septic arthritis + osteomyelitis; <38.5° in transient synovitis); well/ill; local signs; trauma; gait; neurological exam; feet and shoes00History: trauma, fever, systemic illness (viral illness, bacterial focus; fever, anaemia, malaise, weight loss, loss of appetite), acute / chronic, PMH (diabetes, sickle cell, haemophilia), pain (early morning stiffness = rheumatoid arthritis, nocturnal = bone neoplasm); drug history; NAI Examination: fever (>38.5° in 70% septic arthritis + osteomyelitis; <38.5° in transient synovitis); well/ill; local signs; trauma; gait; neurological exam; feet and shoes2413002580005Hip00Hip15481302580005Transient synovitis: 72%; 3-8yrs; recent URTI; mild-mod symptoms (can still walk); especially internal rotation sore; otherwise well; fever usually low gradeSeptic arthritis: 9%; severePerthe’s disease: 4%; 2-12yrs (usually 4-8yrs; younger than SUFE); avascular necrosis of femoral head; 20% bilateralSUFE: early adolescence (older than Perthes); often overweight; external rotation and shortening; especially internal rotation soreJuvenile chronic arthritis: mean age 6yrs; autoimmune?cause: 15%Other differentials: osteomyelitis, inflamm mono-arthritis, bone tumour, rheumatoid arthritis, Behcets, psoriasis, rheumatic fever, bacterial endocarditis, Gonorrhoea, SLE00Transient synovitis: 72%; 3-8yrs; recent URTI; mild-mod symptoms (can still walk); especially internal rotation sore; otherwise well; fever usually low gradeSeptic arthritis: 9%; severePerthe’s disease: 4%; 2-12yrs (usually 4-8yrs; younger than SUFE); avascular necrosis of femoral head; 20% bilateralSUFE: early adolescence (older than Perthes); often overweight; external rotation and shortening; especially internal rotation soreJuvenile chronic arthritis: mean age 6yrs; autoimmune?cause: 15%Other differentials: osteomyelitis, inflamm mono-arthritis, bone tumour, rheumatoid arthritis, Behcets, psoriasis, rheumatic fever, bacterial endocarditis, Gonorrhoea, SLE2286001141730Aetiology00Aetiology1548130210248511-16yrs0011-16yrs22440902102485SUFE, overuse, osteochondritis dessicans, chondromalacia, complex regional pain syndrome00SUFE, overuse, osteochondritis dessicans, chondromalacia, complex regional pain syndrome154813016224254-10yrs004-10yrs22396451622425Transient synovitis; Perthes; juvenile arthritis; leg length discrepancy, rheumatic fever, haemophilia, HSP00Transient synovitis; Perthes; juvenile arthritis; leg length discrepancy, rheumatic fever, haemophilia, HSP154813011417301-3yrs001-3yrs22396451141731Transient synovitis; toddler’s fracture; NAI; developmental dysplasia; juvenile arthritis neuromuscular disease; haemophilia; HSP; rickets00Transient synovitis; toddler’s fracture; NAI; developmental dysplasia; juvenile arthritis neuromuscular disease; haemophilia; HSP; rickets246380539750The Limping Child00The Limping Child 306070539750SUFE(cntd)00SUFE(cntd)1616710539750XR: AP: line though greater trochanter epiphysis should cut through femoral head epiphysis; always XR both hips to compare to other side for slip Lateral: Line on lateral should bisect head of NOF; mild <1/3, mod <1/2, severe >1/2Stable if: chronic, can walk, no effusion, evidence of remodellingUnstable if: acute, can’t walk, effusion present, no remodellingMng: OT00XR: AP: line though greater trochanter epiphysis should cut through femoral head epiphysis; always XR both hips to compare to other side for slip Lateral: Line on lateral should bisect head of NOF; mild <1/3, mod <1/2, severe >1/2Stable if: chronic, can walk, no effusion, evidence of remodellingUnstable if: acute, can’t walk, effusion present, no remodellingMng: OT ................
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