Acute limping child

Question 1

Common differentials of acute limping child

Answer 1

Transient (Toxic) synovitis - TOP CAUSE

• Septic Arthritis
• Trauma
• Osteomyelitis
• Infective myositis
• Perthes
• SUFE
• Fracture

Question 2

Less common differentials of acute limping child

Answer 2

NAI
Tumour
Endocrinopathies

Question 3

Commonest anatomical region causing limp

Answer 3

Hip

Question 4

Age onset of limp caused by

• toxic synovitis
• septic arthritis

Answer 4

2-12

0-5

Question 5

Questions to ask when taking a history of someone with an acute limp

Answer 5

Duration and progression of limp?
Recent trauma and mechanism?
Associated pain and its characteristics?
Accompanying weakness?
Time of day when limp is worse?
Can the child walk or bear weight?
Has the limp interfered with normal activities?
Presence of systemic symptoms like fever, weight loss?

PMH
DH
FH

Question 6

Examination of someone with acute limp

• LOOK
• FEEL
• MOVE

Answer 6

LOOK:

• Check sole of foot for foreign bodies
• Deformity? Erythema? Swelling? Effusion?
• limitation of active ROM, asymmetry.
• Assess shoes for unusual wear on the soles, asymmetry, point of initial foot strike, and also assess the fit.
• In older children look for scoliosis, midline dimples, and hairy patches, which could indicate spinal pathology.
• Assess gait with the child barefoot.
• Assess thigh or calf circumference for asymmetry
• Leg length assessment

FEEL + MOVE - spine, hip, knee, ankle, foot

Question 7

Initial investigations of potential hip infection/inflammation (septic arthritis, OM, transient synovitis)

Answer 7

Bloods

• FBC - maybe high WCC
• CRP/ESR
• CK
• Cultures

XR
USS

Question 8

What criteria is used to tell the difference between septic and transient synovitis (they are very similar), technically is criteria for septic arthritis

What 4 features does it consider

Answer 8

Kocher criteria

• pyrexia
• weight bearing ability
• WBC count >12000
• ESR

Question 9

Symptoms/signs
+ treatment

of septic arthritis (typically s. aureus)

Answer 9

See table

Question 10

Features that raise concern of the limp being caused by a neoplasm

Answer 10

Night pain
Often incidental trauma
Stops doing sport/ going out
Sweats and fatigue
Abnormal blood results- low Hb, atypical blood film, atypical platelets