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The Limping Child A common reason for a child to present Long list of potential diagnoses, some of which demand urgent treatment How do they present? Examination Move –Assess ROM, laxity, stiffness with guarding, pain, discomfort, and fluidity –Assess gait with the child barefoot.
Septic arthritis BCs +ve, raised WCC + CRP XR show delayed changes Bony changes not evident for 14-21 days By 28 days, 90% show some abnormality.
Septic arthritis - Mx Joint aspiration is the definitive diagnostic procedure and the most common pathogen isolated is Staph aureus Emergency orthopaedic consultation with subsequent aspiration, arthroscopy, drainage + debridement required. Perthes’ disease Self-limiting hip disorder caused by varying degrees of ischaemia and subsequent necrosis of the femoral head.

Slipped capital femoral epiphysis Usually occurs at the onset of puberty and most often in children who are either very tall and thin, or short and obese. Aims and Objectives How to assess the limping child who presents to the GP Investigations Common diagnoses Basic management. Toddlers tend to flex hips, knees, + ankles more than adults in order to lower their centre of gravity + improve their balance. Both intra-abdominal pathology and testicular torsion may present simply as a limp – examine abdomen and testicles in boys!!
Beware limitations of paediatric history, possibility of unintentional trauma Associated pain and its characteristics?

Increased risk with: –low birth weight –short stature –low socio-economic class –passive smoking. Roll test; with patient lying supine, roll the hip of the affected extremity into external + internal rotation.

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