Limp (peds)
Background
- 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
Other causes of limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
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
- ESR > 40
- WBC > 12
- Refusal or inability to weight bear on affected joint
- Fever
| Number of Kocher Criteria | Chance of Septic Joint |
| 1 | 3% |
| 2 | 40% |
| 3 | 93% |
| 4 | 99% |
Management
Disposition
References
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