Limping child

Question 1

key points for the limping/ non weight bearing child

Answer 1

Most children presenting with a limp do not require investigations
Observing the child’s gait may help localise the problem and narrow the differential diagnosis
Acute inability to walk or weight-bear is a red flag
Septic arthritis is an orthopaedic emergency and should be considered in all limping children with severe localised joint pain and fever
Transient synovitis, acute myositis and minor trauma are common causes of limp in children, but serious pathology should be excluded
Pain causing limp can be referred. Therefore, a thorough assessment of joints above and below (including the spine and other relevant body systems) is essential to accurately localize the source

Question 2

red flags for limping/ non weight bearing child

Answer 2

• Duration of symptoms >7 days
• History of trauma, falls or injury
• Pattern and severity of pain and limp: severe localised joint pain should raise suspicion for septic arthritis
• Change to urinary or bowel habit
• Functional limitations: complete inability to walk or weight-bear may indicate significant pathology
• Nocturnal pain and symptoms
• Systemic symptoms: fever, night sweats, chills, rigors, rash
• Constitutional symptoms eg unplanned weight loss, lethargy/easy fatigue, anorexia (consider malignancy/haematological cause)

Generalised wasting, pallor, interaction with carer
Fever

Question 3

What examinations to perform on a limping/ non weight bearing child?

Answer 3

Vitals - fever
Gait
Joint examination - incl above and below
NV status of affected limb
Abdo, scrotum, back/spine
Skin for petechiae/purpura/ecchymosis - HSP, ca

Question 4

Differentials of limping/ non weight bearing child according to age

Answer 4

Toddler (0-4): transient hip synovitis, acute myositis, toddler’s fracture, DDH

Child (5-10): transient hip synovitis, acute myositis, DDH, perthes

Adolescent (>10): stress fractures and sprains, traction apophysitis (Osgood Schlatter and Severs), SUFE

All ages: OM, septic arthritis, bursitis, discitis
Trauma, NAI
Ca
Rheumatological/immunological disorders: reactive arthritis, autoimmune arthritis, Henoch Schonlein Purpura, vasculitis, serum sickness, post infectious arthritis, Guillain-Barre syndrome
Intra-abdominal pathology or genitourinary conditions eg appendicitis, ovarian or testicular torsion
Haematological: vaso-occlusive crisis (sickle cell), haemophilia
Functional limp

Question 5

When would yopu