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[The limping child with a painful hip]
Philippe Gicquel1, Marie-Christine Giacomelli, Claude Karger
1Service de Chirurgie Infantile, Hôpital de Hautepierre, Strasbourg. Philippe.Gicquel@chru-strasbourg.fr
Insights
Pediatric hip pain often causes limping. Key causes in children under 10 include septic arthritis, transient synovitis, and Perthes disease, while adolescents may have slipped capital femoral epiphysis.
Area of Science:
- Pediatric Orthopedics
- Pediatric Rheumatology
Context:
- Hip pain is a common pediatric complaint leading to limping.
- Diagnosis relies on age, history, morphology, and imaging (X-ray, ultrasound).
Purpose:
- To outline the differential diagnosis of pediatric hip pain based on age and clinical presentation.
- To highlight urgent vs. long-term management strategies for common pediatric hip conditions.
Summary:
- In children under 10, consider septic arthritis (urgent), transient synovitis, and Perthes disease (requires monitoring for surgical intervention).
- In adolescents, especially overweight ones, slipped capital femoral epiphysis requires prompt surgical fixation to prevent long-term deformity.
Impact:
- Early diagnosis and appropriate management are crucial for optimal outcomes in pediatric hip conditions.
- This approach aims to prevent long-term sequelae such as avascular necrosis and joint deformity.
Abstract:
Hip pain is a frequent cause for limping in children. Etiology work out is oriented by the age of the child, the existence of a traumatic or infectious background, the child's morphology and ethnic origin, and most of the diagnoses will require only a standard X-ray and an ultrasound to be confirmed. In this way, the three main causes to be considered in children of less than 10 years of age are septic arthritis, transient synovitis and Perthes disease. Septic arthritis will require an urgent treatment, whereas Perthes disease will need a long care and follow up in order to watch for a poor outcome that will necessitate a surgical treatment to restore containment of the femoral head. In the adolescent, especially in case of overweight, the first etiology to be considered is slipped femoral capital epiphysis, a condition that requires an early and adequate surgical treatment (in situ screw fixation), in order to avoid further displacement and femoral head deformity of poor prognosis.
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