A child with a limp

Question 1

What are the differentials for a child with a limp?

Answer 1

• osteomyelitis, Perthes disease, transient synovitis of the hip, neuromuscular, NAI, JIA
• DDH (from newborn to 2 yrs ish), SUFE (adolescence)

Question 2

What is transient synovitis of the hip (irritable hip)?

Answer 2

• inflammation of the inner lining of the capsule of the joint
• self-limiting

Question 3

What are some red flags for an NAI (non-accidental injury)?

Answer 3

• inconsistent or changing history
• multiple/delayed presentations
• fractures/bruises not keeping with normal childhood patterns
• child is withdrawn/body language around parents

Question 4

What are some red flags which require urgent referral?

Answer 4

• age <3 yrs OR >9 yrs with painful hip movements (internal rotation), SUFE
• unable to weight-bear, fever/systemic symptoms, severe pain, maltreatment

Question 5

What type of gait would be present in a child with late DDH or neuromuscular conditions?

Answer 5

• Trendelenburg gait

Question 6

A child standing has a leg that is held in external rotation, what is the likely diagnosis?

Answer 6

• Slipper upper femoral epiphysis (SUFE)

Question 7

A child has a leg which is shorter than the other, what is the likely diagnosis?

Answer 7

• typical of DDH
• apparent shortening will be present if there is any fixed flexion deformity

Question 8

What is the Kocher criteria used in paediatrics?

Answer 8

• Kocher criteria: used to differentiate transient synovitis and septic arthritis in children with hip pain
• 4 criteria: high WCC, inability to weight-bear, fever >38.5°C, high ESR
• (note: 4/4 is 99% chance of septic arthritis)