The limping child

The limping child- a summary of main causes and assessment in general practice.

Causes can be divided based on age, anatomy or pathology.

Infants < 1 year -Trauma including NAI Septic arthritis / osteomyelitis Developmental dysplasia of hip.Young children 1-4 yrs -Transient synovitis Trauma including NAI and toddler's fracture Septic arthritis / osteomyelitis Developmental dysplasia of hips (DDH ) Perthe's disease.School aged children-Trauma Transient synovitis Septic arthritis / osteomyelitis Perthe's disease Psychogenic pain -less common. Older children/ adolescents -Trauma Septic arthritis / osteomyelitis SUFE Inflammatory arthritis Chondromalacia Psychogenic pain. All age groups-Septic arthritis Osteomyelitis Juvenile idiopathic arthritis Reactive arthritis Non-malignanyt haematological disease e.g haemophilia , sickle cell Metabolic disease e.g rickets Neuromuscular disease e.g cerebral palsy , spina bifida Malignancy Non-accidental injury

septic arthritis -Septic arthritis ( SA ) / Osteomyelitis ( OM )○ acute onset of joint pain○ fever○ inability to weight bear○ unwell appearing child Can be difficult to differentiate from transient synovitis ( Kochers criteria can be used to differentiate ) In SA hip- hip held flexed and abducted Orthopaedic emergency Complications include○ sepsis○ cartilage destruction○ growth plate damage○ avascular necrosis of the femoral head

Transient synovitis -Commonest cause of non-traumatic acute hip pain in children Onset...