Pediatric Orthopedics

Limping Child

limping child

Limping child

Limping child.  Limping and unable to weight bearing because of pain are the most commonly seen problems in Paediatric Orthopaedics practice. There are several causes of limping such as trauma, infection, transient synovitis, Legg-Calve-Perthes disease, hip dysplasia and etc.

Trauma

Patients sustained from trauma usually give the history of fall down, twist, stepping on a sharp object. They do not have fever, and pain in localised  extremity part. One can see the other injury finding like skin lacerations, erosions, swelling and, etc. Your doctor may ask for radiological tests. Treatment depends on the injury type.

Transient Synovitis, Limping child.

Patients with transient synovitis have the history of limping and difficulty in weight bearing with a spontaneous onset for a day or two. Most children have the history of an infection like upper respiratory or middle ear. The involvement is unilateral in most cases with some degree of limitation in joint motion. Ultrasonographic exam shows joint effusion. Radiographic exam is usually normal other then mild joint space widening. Rest and anti-inflammatory medicine would be enough in most cases and resolves in a week to ten days.

Infection

Rarely, some patients may have either joint infection so called septic arthritis or osteomyelitis, some infection. Infection may require urgent treatment. Child with infection positions his joint and extremity in the more comfortable position. Passive joint motion may be extremely painful. Swelling, redness and tenderness are the other clinical findings.Pediatric Orthopedic surgeon may run radiological and blood tests. If suspected, aspiration of the joint or bone may be required to confirm diagnosis and bacteria evaluation. Antibiotics are begun as soon as diagnostic evaluation completed. In most cases, surgical drainage may be required.

Perthes

Legg-Calve-Perthes disease is seen commonly between the ages of 3 and 10. Boys are more affected then the girls. Main complaint are knee pain, limping and limitation in hip joint motion. Children with Perthes present without fever and normal blood tests. In early stages, radiographs may be normal and MR study can be used to confirm the diagnosis. Treatment aims a good hip motion, spheric femoral head and congurent hip joint. Disease may last 1,5 to 2,5 years. Patients should be followed regularly with physical and radiological exam. If joint congruency is  broken, surgery may be indicated.

Limping child

Perthes disease in Left Hip

About the author

Prof.Dr. Seref Aktas