Limp (peds)

Background

Hip anatomy.

Extracapsular ligaments (anterior right hip).

Extracapsular ligaments (posterior right hip).

• It can be difficult to differentiate hip from knee pain in children
  • Knee pain can be referred pain from the hip

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:
  • Appendicitis
  • Meningitis
  • Epidural abscess (spinal)

Evaluation

Workup

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

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%

See Also

• Pediatric hip pain
• Septic arthritis of the hip (peds)

External Links

• Pediatric Emergency Playbook Podcast: Please Just STOP LIMPING