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Child with a limp

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

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Child with a limp

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  1. Child with a limp

  2. 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

  3. Examination • Lively, general conditionseems 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

  4. Lab • CRP 8 • WBC 10 • SR 12 • Furtherinvestigation? • Admit to hospital?

  5. Imaging • Ultrasound: slightly increased amount of fluid, seems clear • Diagnosis?

  6. Acute bacterial osteomyelitis/septic arthritis

  7. History • Limp • Pain • Avoidance of use of bodypart • Trauma? • General conditionlowered (?) • Fever? • Infection in previousweeks? • Similar symptoms previously?

  8. Clinical examination • Observationofmovement • Limp? • Pain? • Avoidance? • General condition, T, HR, RF – systemic signs of infection? • Systematicalexaminationof joints • Observation: Erytema, swelling? Compare with opposite side • Palpation: Temperature, swelling? • Motion: decreased? Pain? • Neurological examination?

  9. Laboratoryinvestigations • SR, WBC, CRP, blood culture • Synovial fluid sampling

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

  11. 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.

  12. Treatment • Inhalations? • Saline • Racemicadrenaline (epinephrine) • Salbutamol? • Hypertonic saline? • Corticosteroids?

  13. 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

  14. Examination • Good contact, but uninterested in surroundings • HR 120, RF 25 • Leftknee: • Erytema • Swollen • Warm • Painful • Admit to hospital?

  15. Lab • CRP 150 • SR 78 • WBC 22

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