Limp (peds): Difference between revisions
| Line 27: | Line 27: | ||
==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
*X-ray hip (consider bilateral frog-leg view), femur, knee | *X-ray hip (consider bilateral frog-leg view), femur, knee | ||
*Consider CBC, ESR, total CK | *Consider CBC, ESR, total CK | ||
Revision as of 17:33, 21 November 2017
Background
- It can be difficult to differentiate hip from knee pain in children
Clinical Features
- Pediatric patient with a reported limp with ambulation
- May additionally have leg, hip, and/or knee tenderness to palpation
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Other causes of limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
- Appendicitis
- Meningitis
- Epidural abscess (spine)
Evaluation
Workup
- X-ray hip (consider bilateral frog-leg view), femur, knee
- Consider CBC, ESR, total CK
- Consider hip ultrasound (vs CT)
Kocher Criteria for septic arthritis of the hip
- ESR > 40 mm/hr
- WBC > 12,000/microliter
- Refusal or inability to weight bear on affected joint
- Fever 38.5° C or greater
| Number of Kocher Criteria | Chance of Septic Joint |
| 1 | 3% |
| 2 | 40% |
| 3 | 93% |
| 4 | 99% |