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Evaluation of the Child with a Limp DD Aronsson University of Vermont
Hx – 2-year-old boy limps because of pain in the right thigh (antalgic) PE – pain and swelling just above the knee
Differential Diagnosis Bone infection (osteomyelitis) Joint infection (septic arthritis) Fracture Toxic synovitis
Bone & Joint Infections Hematogenous origin – Strep throat Implantation – Stepping on a nail
Osteomyelitis Metaphyseal origin Vessels don’t cross the growth plate
Septic Arthritis Infection can decompress into a joint Septic dislocation
Clinical Findings Systemically ill Irritable Refusal to bear weight Pseudoparalysis Pain & the site
Laboratory Studies Elevated WBC,ESR, & CRP 50% Positive blood culture Infant – May be normal
Imaging Radiographs – Soft tissue swelling Bone scan – Increased uptake
Treatment Aspiration is the “key” to the diagnosis Don’t wait for imaging Subperiosteal aspiration
Treatment IV antibiotics – S aureus, gram-negative enteric, & Group B Streptococcus Surgical decompression – Hip & shoulder
Hx – 18 month-old girl limps on the left leg (no pain) PE – short left lower extremity is causing the limp
Differential Diagnosis Developmental dysplasia of the hip Limb-length discrepancy
DDH Instability Subluxation Dislocatable Reducible dislocation Irreducible dislocation
Etiology Unknown Multifactorial Geneticwhites Physiologicgirls Mechanicalbreech Environmentalswaddling
Barlow Provocative Test Dislocates hip (exit) Clunk
Ortolani Maneuver Reduces dislocated hip (entry) Abduction Clunk
PE > 3 Months 57º 43º Limited abduction is key
PE > 3 Months Asymmetric thigh folds – Limb-length discrepancy
Ultrasound Alpha > 60º – Slope of osseus acetabulum
Pavlik Harness Success Dysplasia 95% Dislocated 80%
Hx – 6-year-old boy limps on the right leg PE – limp with painful range-of-motion of the hip
Differential Diagnosis Infection Toxic synovitis Slipped capital femoral epiphysis (endocrine) Legg-Calv -Perthes disease
Legg-Calv -Perthes Loss of blood supply of the epiphysis
Legg-Calv -Perthes History – Pain in the groin or knee – Limp – Aggravated by exercise
Legg-Calv -Perthes Physical examination – Decreased internal rotation – Decreased abduction – Irritable hip
Necrotic stageFragmentation stage
Reossification stageRemodeling stage
Treatment Containment – Physical therapy ROM exercises – Orthosis Abduction & internal rotation – Osteotomy
Toxic synovitis History – sudden onset – Pain in groin or thigh – Painful limp – URI 2 weeks ago
Physical Examination Limp Irritable hip with guarding Mimic septic hip
Treatment Activity modification Expect improvement Question diagnosis if not responding
Hx – 14-year-old obese boy has pain in the right knee and limps PE – no swelling and full ROM of the knee but decreased internal rotation of the hip
Differential Diagnosis Infection Osgood-Schlatter disease Anterior knee pain Slipped capital femoral epiphysis
Slipped Capital Femoral Epiphysis (SCFE) Most common hip disorder in adolescents Age – Boys 14 y/o – Girls 12 y/o
Etiology Endocrine – Hypothyroid – Growth hormone treatment Mechanical – 63% > 95th percentile weight
Hip Flexion Causes Abduction & External Rotation FABER
AP Pelvis Radiograph Wide & irregular physis Epiphysis at or below Klein’s line Klein’s line
Frog Pelvis Radiograph Posterior slip Wide, irregular physis
Preop AP pelvisPreop frog pelvis
Postop AP pelvisPostop frog pelvis
Limp Think hips
DIAGNOSIS OF SEPTIC JOINT IN CHILDREN Sara Jane Shippee UW Orthopaedic Surgery, PGY-1 Seattle Children’s Hospital 11/1/2012.
Common Pediatric Hip Problem Dr. Abdulmonem Alsiddiky, MD, SSCO Associate professor & consultant Pediatric Orthopedic & Spinal Deformities.
James Pegrum (Peggers) MB BS BSc MSc (SEM) MRCS (Eng) Diploma in MM (UIAA)
Slipped capital femoral epiphysis (SCFE). SCFE Posterior and Medial displacement of the femoral capital epiphysis on the femoral neck through sudden.
APPROACH TO LIMB PAIN IN CHILDREN/OSTEOMYELITIS MR 7/17/09 J.Chen.
Common Hip Disorders In Children Dr.Kholoud Al-Zain Assistant Prof. Ped. Orthopedic Consultant April 2012 (Acknowledgment to 5 th cycle students 2010)
Good Morning!. 4-month-old Well Child visit Illness Scripts Predisposing Conditions – Age, gender, preceding events (trauma, viral illness, etc), medication.
Dr. FATEMA AL TAMIMI Pediatric rheumatology consultant.
Prof. Mamoun Kremli AlMaarefa College The limping child.
Pediatric Orthopedic Diseases. Categories Congenital Developmental Neuromuscular Metabolic Acquired : inflammatory infection trauma tumor.
The Limping Child AAPA. Definition Limp = Asymmetry Joint - Range of motion Bone - Deformity Pain Control.
Pediatric Lower Extremity Orthopedic Concerns Esther Tompkins, DO Ped’s PM&R.
Nontraumatic Orthopedic Emergencies. Objectives Understand the pathophysiology of nontraumatic orthopedic conditions. Describe the management of nontraumatic.
Legg- Calve – Perthes disease. Anatomy Acetabular retroversion.
Myra Lalas Pitt Morning Report 9/12/11. Orthopedic/Mechanical Slipped capital femoral epiphysis Legg-Calvé-Perthes disease Trauma/Overuse Fracture.
Disease and Injury of the Hip By Ly Nguyen & Hayley Lough.
CDH Congenital Dislocation of the Hip Prof. Mamoun Kremli AlMaarefa College.
Slipped Capital Femoral Epiphysis SCFE دکتر مظلومی دانشیار ارتوپدی دانشگاه علوم پزشکی مشهد.
Common Pediatric Hip Problem Prepared by Pediatric Orthopedic gruop Surgeons KKUH.
Paediatric Orthopaedics E.E.Fogarty F.R.C.S.I, F.R.A.C.S.
The Limping Child Christopher M. Prior, DO MAJ, MC, USA Primary Care Sports Medicine.
TRIPLE PELVIC OSTEOTOMY FOR THE TREATMENT OF HIP DYSPLASIA.
The most common disorder affecting the hip in children Definition A progressive deformation of previously normally formed structures during the embryonic.
Pyogenic Bone and Joint Infection Abdulaziz Al-Ahaideb FRCSC.
Legg Calve Perthes Disease Joseph Donnelly, M.D. December 10, 2001.
Dr. ABDULMONEM ALSIDDIKY, MD, SSCO. Assistant Professor & Consultant pediatric Ortho.& Spinal Deformities KSU,KKUH Riyadh, Saudi Arabia.
Allison Eliscu, MD, FAAP Rev. Aug What is SCFE? Salter Harris I fracture through proximal femoral epiphysis Displacement of femur distal to physis.
March 22, Most common organism? Staph Aureus Presentation? Acute Monoarthritis Erythema Warmth Swelling Intense pain.
1 Pediatric Orthopedics Rounds Nov 2002 Abdulaziz Al-Ahaideb.
Selina Silva, MD UNM Carrie Tingley Hospital. Intoeing/ Outoeing Bowlegged/ knock-kneed Flexible Flatfeet Growing Pains Septic Joints Legg-Calve-Perthes.
Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.
Common Pediatric Hip Problem Dr.Abdulmonem Al-Siddiky Dr.Kholoud Al-Zain Dr.Khalid Bakarman Assistant Professors Consultant Pediatric Orthopedic Surgeons.
Evaluation of the Child with Acute Limp Bruce Minnes MD, FRCPC Staff Physician and Assistant Professor, Division of Paediatric Emergency Medicine Chief.
X-Ray Rounds Cass Djurfors Feb 20, y.o. boy with leg pain Obese 10-year old male presents with a two week history of right thigh and knee pain.
CASE CONFERENCE Qadeer Ahmed PEM Fellow 03/05/2015.
2/11/2016 Jenelle Beadle Developmental Dysplasia of the Hip.
DEVELOPMENTAL DYSPLASIA OF THE HIP Melih Güven, M.D Assoc. Prof. Yeditepe University Hospital Department of Orthopaedics and Traumatology Istanbul.
Vanderbilt Sports Medicine SEACSM Clinical Conference Hip Pain while Playing Hoops Doug Connor, MD Pediatric Sports Medicine Fellow Vanderbilt University.
Unusual Complication in a septic hip Jong Sup Shim Samsung Medical Center Sungkyunkwan University School of Medicine.
A Limping Child Laura Cuthbert. Overview An unusual presentation Key learning points Differential diagnosis Some specific examples Case discussion.
Evaluation of a Painful Total Knee Arthroplasty Sarat Kunapuli, DO EASTERN OKLAHOMA ORTHOPEDIC CENTER.
Hip Pathology for General Practice Richard Freeman FRCS Eastbourne DGH October 2013.
Lower Extremities Third Part Dr Mohamed El Safwany, MD.
The Limping Child David C Koronkiewicz, D.O. IU Goshen Orthopedics and Sports Medicine I0A 30 th Winter Update
Orthopedics Disorders Pediatrics Part II Jan Bazner-Chandler RN, MSN, CNS, CPNP.
Thigh and knee pain in an obese 10 year old Pediatric Case Presentation By Annerie Hattingh 28 October 2009.
Approach to limping child Done by Group A1. Case Scenario A 14 month old boy is brought to the office because the parents noticed a limp this morning.
MUSCULOSKELETAL DISORDERS THE MUSCULOSKELETAL SYSTEM Bones and bone growth –Epiphyseal plates…bone growth occurs here and when these seal over, there.
CHAPTER 24 SPECIAL CONCERNS OF THE PEDIATRIC PATIENT ROTATIONAL DEFORMITIES Intoeing – “pigeon toed”, common. Usually spontaneously corrects. Metatarsus.
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