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Child with a limp

This case study presents two pediatric patients with acute limping. The first case involves a 1.5-year-old with upper airway symptoms, a sudden limp, and pain in the right hip, leading to a diagnosis of acute bacterial osteomyelitis/septic arthritis. The second case discusses a 5-year-old with fever, loss of appetite, and painful swelling in the left knee, ultimately requiring hospitalization for management of a potential infection. Proper examination, lab work, and imaging are crucial for accurate diagnosis and treatment.

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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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