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Orthopedics – Limp in Children
Whiteboard Animation Transcript
with Lindsay Davidson, MD
https://medskl.com/Module/Index/limp-...


Although most limps in children are caused by injury or overuse, it is important not to miss a serious problem such as an infection or a slipped capital femoral epiphysis.

Children with musculoskeletal infections present acutely and are ill.

Look for systemic signs and symptoms including fever and chills.
These children have a lot of pain and may refuse to weightbear or move their affected joint completely.

A careful physical examination will identify

joint guarding (in the case of septic arthritis) or
tenderness in the metaphysis of a long bone (in the case of osteomyelitis).

In cases of musculoskeletal infection treatment includes antibiotics sometimes combined with surgical drainage. Delayed surgical drainage of a septic hip can lead to joint damage and avascular necrosis.

Slipped capital femoral epiphysis (SCFE) is a condition that occurs around puberty.

Look for it in adolescents and young teens, particularly those with a high BMI. Onset may be more chronic and achy or acute and intensely painful.
On physical exam look for a Trendelenburg gait, external rotation of the affected foot and a lack of active and passive hip internal rotation.

Slipped capital femoral epiphysis is treated with surgical stabilization of the affected hip, preventing progressive deformity that can lead to arthritis.

If you suspect bone or joint infection or SCFE, seek specialist consultation emergently. Do not administer antibiotics or allow the patient to weight bear until you have discussed the patient with an orthopaedic surgeon.