#ortho see also: [[upper limb non-use]], [[bone and joint infection (paeds)]] - [Cameron paeds -- child with limp](x-devonthink-item://E383FFBD-9FD8-4DE9-B350-0F6F60D3E600?page=2045) - [Dunn - paediatric orthopaedic conditions](x-devonthink-item://DED015C9-3D41-4D2D-B175-1F929BCB727E) ![[Pasted image 20230825211953.png]] # Dx by age ## All ages - infections -- [[bone and joint infection (paeds)|osteomyelitis]] or [[bone and joint infection (paeds)#Kocher signs of septic arthritis|septic arthritis]], discitis, myositis - [[Non-accidental injury|NAI]] - malignancy -- ALL, bone tumour - reactive arthritis - [[Testicular torsion]] - functional limp - [[Sickle Cell Anaemia]] ## Toddler 1-4 y - developmental dysplasia of the hip - [[toddler's fracture]] - [[transient synovitis]] of the hip - child abuse - [[meliodosis]] ## Child 4-10 - transient synovitis of the hip - [[Perthes' disease]] (avascular necrosis of femoral head) ## Adolescent >10 - [[slipped upper femoral epiphysis]] - overuse/stress fracture *headings based example for DDx age 4-10* - Trauma: NAI, toddler’s fracture - Infective: septic arthritis, osteomyelitis - Reactive: transient synovitis, myositis - Orthopaedic: Perthe’s (avascular necrosis of femoral head) Malignant: ALL # history - hx of rauma - duration - joints involved - character of pain - site of pain and severity - *systemic features* - preceeding viral illness - bacterial focus - fever, anaemia, malaise - weight loss/loss of appetite - PMx - chronic illness eg diabetes, sickle cell, haemophilia - previous attendences ? [[Non-accidental injury|NAI]] - birth and development hix - Rx history - analgesia requirements - allergies - social - eg NAI risks >[!warning] Red flags >- severe localised joint pain ([[bone and joint infection (paeds)|septic arthritis]]) >- suspicion of [[Non-accidental injury|NAI]] >- persistent symptoms > 7 days >- suspicion for malignancy >- systemic symptoms: fever, weight loss, lethargy, anorexia >- [[Petechiae]] -- consider HSP, haematological cause, malignancy >- complete inability to walk/weight bear # exam - observe appearance and gait - neuro exam - ?generalised lymphadenopathy - bruising -- excessive or in unuusual places - abdo/scrotum/ inguinal hernias - bony tenderness - examine all jonts for tenderness # Ix - if suspecting specific dx - well children w/ limp <3 days usually don't need further ix - bloods -- inflammatory markers - imaging - plain films, uS for effusion ?septic hip # dispo - suspected transient synovitis -- rest, analgesia, GP f/u and return advise - suspected SUFE, perthes, infection - refer ortho - d/w paeds if concern about NAI # Related questions - [ ] [Child with a limp](x-devonthink-item://F0498813-9350-484C-AD5B-6FF7C3AE9015?page=45) -- [Answer](x-devonthink-item://A491A3F6-FD6D-492F-BCBE-7F7BAE101EDF?page=48) - [ ] [Child with a limp 2](x-devonthink-item://834C484F-DDAA-4819-8DF0-84AE5E70DA1D?page=57) -- [Answer](x-devonthink-item://D46998FE-62E2-4A3A-860D-C32C94B86E42?page=24) - [ ] [Child with a limp 3](x-devonthink-item://1EA9311E-0B9E-49F7-8D6E-4C4187A838C4?page=55) -- [Answer](x-devonthink-item://B1CB2E8F-5D04-49EE-8274-043871389D28?page=35)