The limping child: epidemiology, assessment and outcome

Abstract

We investigated the epidemiology, assessment and outcome of acute atraumatic limp in 243 children under the age of 14 years presenting to a paediatric accident and emergency department (AED) over a period of six months. Data were collected at presentation and medical notes were re-examined after 18 to 21 months. The incidence of limp was 1.8 per thousand. The male:female ratio was 1.7:1 and the median age 4.35 years. Limp was mainly right-sided (54%) and painful (80%); 33.7% of the children had localised pain in the hip. A preceding illness was found in 40%. The main diagnosis was 'irritable hip'/transient synovitis (39.5%); Perthes' disease accounted for 2%. Most patients (77%) were managed entirely in the AED. Acute atraumatic limp is a common problem in children presenting to the AED. Most can be safely managed there if guidelines are followed and will have a benign outcome. Further studies are needed to identify the role of preceding illness in the aetiology of acute atraumatic limp.

Managing children with acute non‐traumatic limp: the utility of clinical findings, laboratory inflammatory markers and X‐rays

“…Ultrasound has been widely advocated as a valuable tool in the assessment of limping children, as it has high sensitivity for diagnosing hip effusion 8,9,11 . However, it is important to remember that it cannot differentiate a reactive effusion from septic arthritis.…”

“…There have been several studies comparing different algorithms for assessing acute limp, 1–9 based on combinations of clinical signs, blood inflammatory markers and radiological investigations. There remains considerable variation in recommendations and no consensus as to the best approach.…”

Tibial torus and toddler's fractures misdiagnosed as transient synovitis: a case series

“…Difficulty in bearing weight on a leg, characteristic of an acute onset of a limp, suggests the diagnosis of TS [2,3,8,9,13-15] While limitation of internal rotation is the most common finding, referred pain in the knee can occasionally be the predominant complaint [4]. In the reported cases, passive rotations of the hip joint, tested with 90 degrees of hip and knee flexion, were painful.…”

Development of a High-Resolution Infrared Thermographic Imaging Method as a Diagnostic Tool for Acute Undifferentiated Limp in Young Children.

“…A UK study reported the incidence of a non-traumatic limp as 1.8 in every 1000 children aged under 14 years, but the true incidence representing all limp is much higher [1]. An 'acute' limp is defined in a patient presenting with symptoms of recent onset, often in the last 48 hours.…”