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The limping child (Aetiology (Degenerative
Slipper Upper Femoral…
The limping child
Aetiology
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Congenital/developmental
Cerebral palsy
Developmental dysplasia of the hip (DDH)
Duchenne muscular dystropy
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Trauma
Fracture (Toddler's, greenstick etc.)
Abuse
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Diagnosis
Examination
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Musculoskeletal exam
Spine, hip and knee
Neurovascular status
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Investigations
Bloods
FBC, CRP/ESR (infection/inflammation),
U+E, LFT, bone profile (metabolic bone disease)
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History
PC/HPC
Age (affects differentials)
Any trauma (even minor)
Recent systemic illness e.g. URTI
Red flags: weight loss, night sweats, fever
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FH
Arthritis, DDH, Perthe's
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SH
Living arrangements, school/nursery,
activity levels, diet
Clinical
presentation
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Pain
Onset
Sudden - septic arthritis, transient synovitis, SUFE, Perthes
Chronic - DDH, JIA, cerebral palsy
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Site
May be hip, groin, or radiate to knee
(depending on cause)
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Associated symptoms
Limp (often antalgic gait)
May or may not be able to weight bear
Systemic upset (fever etc.) - septic arthritis, transient synovitis
Other joint involvement - JIA
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Infection: septic arthritis, transient
tenosynovitis, osteomyellitis
Trauma: Toddler's fracture, NAI
Neoplastic: leukaemia, neuroblastoma
Vascular: Perthe's disease
Infection: septic arthritis, transient
tenosynovitis, osteomyelitis
Trauma: Greenstick fracture
Autoimmune: JIA
Neoplastic: leukaemia
Infection: septic arthritis, reactive
arthritis, osteomyelitis
Trauma: sports/accidents, SUFE,
osteochondritis dissicans
Neoplastic: **bone tumours**
Vascular: Perthe's disease
Autoimmune: JIA
Congenital/dev: DMD, tarsal coalition
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Congenital/dev: DDH, talipes, cerebral palsy
Autoimmune: JIA