tailieunhanh - Khập khiễng: Đánh giá và chẩn đoán

Khập khiễng là một lý do phổ biến cho một đứa trẻ để trình bày để thuật chỉnh hình. Bởi vì danh sách dài các chẩn đoán tiềm năng, một số trong đó nhu cầu điều trị khẩn cấp, một cách tiếp cận được tổ chức để đánh giá là bắt buộc. Với hiểu biết của dáng đi bình thường và bất thường | The Limping Child Evaluation and Diagnosis John M. Flynn MD and Roger F. Widmann MD Abstract A limp is a common reason for a child to present to the orthopaedist. Because of the long list of potential diagnoses some of which demand urgent treatment an organized approach to evaluation is required. With an understanding of normal and abnormal gait a directed history and physical examination and the development of a differential diagnosis based on the type of limp the patient s age and the anatomic site that is most likely affected the orthopaedist can take a selective approach to diagnostic testing. Laboratory tests are indicated when infection inflammatory arthritis or a malignant condition is in the differential diagnosis. The C-reactive protein assay is the most sensitive early test for musculoskeletal infections an abnormal value rapidly returns to normal with effective treatment. Imaging should begin with plain radiography. Ultrasonography is particularly valuable in assessing the irritable hip and guiding aspiration if necessary. J Am Acad Orthop Surg 2001 9 89-98 A limp is a common reason for a child to present to the orthopaedist often after first being seen by a primarycare physician or in an emergency department. Most parents are keen observers they are quick to detect even subtle gait abnormalities and generally will not wait long to have a limp evaluated. The orthopaedist is expected to recognize the gait abnormality determine the probable site of origin and then develop a good working diagnosis before ordering selective diagnostic tests. These tests should provide the data for confirming the diagnosis and developing a treatment plan while decreasing costs to the health-care system as well as minimizing pain and anxiety for the child and parent. Pain weakness and mechanical factors are the primary causes of limp in children. The etiology of a limp ranges from benign self-limited conditions that call for only a diagnosis and reassurance . tran sient .