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Limp (peds)
From WikEM
Contents
Background
- It can be difficult to differentiate hip from knee pain in children
Clinical Features
Differential Diagnosis
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- SCFE
- Septic arthritis
- Myositis
- Other:
- Appendicitis
- Meningitis
- Epidural abscess (spine)
Pediatric hip pain
- Septic arthritis of the hip (peds)
- Slipped capital femoral epiphysis
- Legg-Calve-Perthes disease
- Transient (toxic) synovitis
- Acute rheumatic fever
- Juvenile idiopathic arthritis
- Developmental dysplasia of hip
- Femur fracture
Evaluation
- X-ray hip, knee
- Consider CBC, ESR, total CK
- Consider hip ultrasound (vs CT)
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% |
