Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard...

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat

Child with a limp


Case 1: 1,5 year old

• Upper airway symptoms until last week• Fine general condition, no fever or other general

symptoms• Started to limp two days ago• No known specific trauma, but goes to kindergarden

and falls often


Examination

• Lively, general condition seems fine• Walking pattern: avoids weight on right foot, rotated

outwards• T 36,8• Lower extremeties:

– No erytema– No warm skin– No obvious swelling– Manipulation (especially rotation) of right hip seems painful– Palpation seems painful


Lab

• CRP 8• WBC 10• SR 12

• Further investigation?• Admit to hospital?


Imaging

• Ultrasound: slightly increased amount of fluid, seems clear

• Diagnosis?


Acute bacterial osteomyelitis/septic arthritis


History

• Limp• Pain• Avoidance of use of bodypart• Trauma?• General condition lowered (?)• Fever?• Infection in previous weeks?• Similar symptoms previously?


Clinical examination

• Observation of movement– Limp?– Pain?– Avoidance?

• General condition, T, HR, RF – systemic signs of infection?

• Systematical examination of joints– Observation: Erytema, swelling? Compare with opposite side– Palpation: Temperature, swelling?– Motion: decreased? Pain?

• Neurological examination?


Laboratory investigations

• SR, WBC, CRP, blood culture• Synovial fluid sampling


Imaging

• Ultrasound• MRI (general anesthesia)• (X-ray)• (Bone scintigraphy)


Treatment

• Septic arthritis: joint drainage with flushing• antibiotics

– klindamycin– betalactamase-stabile penicillin (kloxacillin)

• osteomyelitis: total 6 weeks, at least 2 weeks intravenous

• septic arthritis: total 3-4 weeks, at least 1-2 weeks i.v.


Treatment

• Inhalations?– Saline– Racemic adrenaline (epinephrine)– Salbutamol?– Hypertonic saline?

• Corticosteroids?


Case 2: 5 year

• 1 day history• Moderately affected general condition,

– Loss of appetite, nausea– Fever

• Pain in left knee, don’t want to walk• No history of trauma or other infections


Examination

• Good contact, but uninterested in surroundings• HR 120, RF 25• Left knee:

– Erytema– Swollen– Warm– Painful

• Admit to hospital?


Lab

• CRP 150• SR 78• WBC 22

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard...

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