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Case 37
Published in Edward Schwarz, Tomos Richards, Cases of a Hollywood Doctor, 2019
Edward Schwarz, Tomos Richards
There are many potential causes of atraumatic hip pain. Septic arthritis can occur in any age and is often seen in accompaniment with fever, an inability to weight bear, raised inflammatory markers and an unwell child. Transient synovitis can mimic infection, but is an inflammatory disorder most often triggered by a recent viral illness. In the older child a slipped upper femoral epiphysis can be the cause, starting around puberty and usually necessitating surgical pinning. Perthes disease of the hip can occur usually between the ages of 4 and 8 years.
Bones and Joints
Published in A. Sahib El-Radhi, Paediatric Symptom and Sign Sorter, 2019
Transient synovitis is diagnosed by a mild or no fever, history of a viral upper respiratory tract infection and one hip being affected. Child appears well – limping but still walking. WBC, CRP and ESR are usually normal; WBC count in the joint fluid is <50,000 cells/mm. It is self-limiting, usually lasting 1–3 weeks.
Single best answer (SBA)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
A 13-year-old boy presents with a limp and associated right hip pain, there is no clear history of trauma. Only an AP film is performed and shows reduced height of the right femoral epiphysis, but normal alignment. The acetabulum is normal and the left hip is unremarkable. What is the most likely diagnosis? Developmental dysplasia of the hip.Perthe’s disease.Non accidental injury.Slipped upper femoral epiphysis.Transient synovitis.
Identifying the response process validity of clinical vignette-type multiple choice questions: An eye-tracking study
Published in Medical Teacher, 2023
Francisco Carlos Specian Junior, Thiago Martins Santos, John Sandars, Eliana Martorano Amaral, Dario Cecilio-Fernandes
Boy, three-year-old, was brought to the Emergency Room with pain in the right lower limb and difficulty in walking for one day. Family history: brother with an upper respiratory tract infection for 10 days. Physical examination: T = 36.8 °C; RR = 16 breaths per minute; HR = 90 beats per minute; Limbs: limitation of internal and external rotation of the right hip; does not perform complete extension of the right lower limb. The most likely diagnosis is:Rheumatic fever.Legg-Calve-Perthes disease.Transient synovitis.Juvenile idiopathic arthritis.
Impact of the COVID-19 pandemic on paediatric orthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the “golden weeks”
Published in Acta Orthopaedica, 2020
Kapil Sugand, Chang Park, Catrin Morgan, Rory Dyke, Arash Aframian, Alison Hulme, Stuart Evans, Khaled M Sarraf, Camilla Baker, Katharine Bennett-Brown, Henry Simon, Edward Bray, Lily Li, Noel Lee, Nadia Pakroo, Kashed Rahman, Andrew Harrison
Children represent approximately 2% of all COVID-19 cases but to reduce the risk of increased spread schools and nurseries closed during this period (Docherty et al. 2020). Subsequently, there is an expectation of a reduction in acute referrals for infection-related pathology in the paediatric population. The current literature suggests that children appear to be less susceptible to the effects of COVID-19, often displaying milder symptoms than their adult counterparts (Dong et al. 2020, Henry et al. 2020, Lu and Shi 2020, Ludvigsson 2020). Nevertheless, there have been a number of documented cases of a more serious associated illness similar to that of Kawasaki vasculitis (Harahsheh et al. 2020, Viner and Whittaker. 2020). The concern in the paediatric population is that COVID-19 may cause an increased incidence in the presentation of transient synovitis, or indeed COVID-related septic arthritis and osteomyelitis. In our study there has been an increase in overall referrals for infection, from 2% in 2019 to 6% in 2020. As the pandemic evolves and more information surfaces, further investigation is required to observe the influence of COVID-19 on paediatric musculoskeletal infections. Although we have found an increase in those being referred for infection, this was statistically insignificant. However, a larger and broader population sample may suggest otherwise.