APPROACH TO THE LIMPING CHILD

Question 1

DDx

Answer 1

Fracture
Non accidental trauma

Transient Synovitis (MCC)
Osteomyelitis
Juvenile Idiopathic Arthritis
Acute Rheumatic Fever
Post Streptococcal Reactive Arthritis

Avascular Necrosis (Legg Calve Perth’s)
Slipped Capital Femoral Epiphysis
Osgood-Schlatter Disease
Cancer

Question 2

DDx for a limping child age 1-4

Answer 2

Developmental Dysplasia of the Hip
Toddler’s Fracture
Transient Synovitis of the Hip
Fracture
Non accidental trauma
Septic Arthritis / Osteomyelitis / Viral Myositis
Rheumatologic Disorder
Malignancy

Question 3

DDx for limping child age 4 - 10

Answer 3

Legg-Calve-Perthes
Transient Synovitis of the Hip
Fracture
Non accidental trauma
Septic Arthritis / Osteomyelitis / Viral Myositis
Rheumatologic Disorder
Malignancy

Question 4

DDx of limping child age > 10

Answer 4

Slipped Capital Femoral Epiphysis
Fracture / Stress Fracture / Overuse syndrom
Non accidental trauma
Septic Arthritis / Osteomyelitis / Viral Myositis
Rheumatologic Disorder
Malignancy

Question 5

Toddler’s Fracture: Mechanism

Answer 5

Twisting mechanism -> Spiral or Oblique undisplaced fracture of the distal shaft of the tibia with an intact fibula

Question 6

Toddler’s Fracture: Management

Answer 6

Back Slab

Question 7

Transient Synovitis of the Hip: Pathology

Answer 7

Acute non-specific inflammatory process affecting the joing synovium.

MCC of hip pain in children aged 3-10.

Question 8

Transient Synovitis of the Hip: Management

Answer 8

Nothing

If severe pain or child appears unwell consider septic arthritis