Limp (peds)

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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 hip pain

Other causes of limping

  • Developmental dysplasia
  • Fracture
  • Neoplasm:
    • Leukemia
    • Ewings
    • Osteogenic sarcoma
    • Metastatic neuroblastoma
  • Osteomyelitis
  • Myositis
  • Other:
    • Appendicitis
    • Meningitis
    • Epidural abscess (spine)

Evaluation

Workup

  • X-ray hip (AP & bilateral frog-leg view), femur, knee
  • Consider CBC, ESR, total CK
  • Consider:
    • Ultrasound to evaluate for effusion
    • CT to evaluate for abscess

Kocher Criteria for septic arthritis of the hip

  1. ESR > 40
  2. WBC > 12
  3. Refusal or inability to weight bear on affected joint
  4. Fever
Number of Kocher Criteria Chance of Septic Joint
1 3%
2 40%
3 93%
4 99%

Management

Disposition

See Also

External Links

References

Authors

Michael Holtz