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Tibial torus and toddler's fractures misdiagnosed as transient synovitis: a case series
Aksel Seyahi1, Serkan Uludag, Burak Altıntaş
1American Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey. aseyahi@gmail.com.
Insights
Transient synovitis in young children can mask subtle lower extremity injuries like toddler fractures. Increased vigilance is needed to differentiate these conditions and ensure accurate diagnosis for better outcomes.
Area of Science:
- Pediatric Orthopedics
- Musculoskeletal Imaging
- Pediatric Emergency Medicine
Background:
- Transient synovitis is a common cause of limping in young children.
- Trauma is often underestimated in non-cooperative toddlers.
- Misdiagnosis of transient synovitis can obscure underlying fractures.
Purpose of the Study:
- To highlight the potential for misdiagnosis of subtle lower extremity fractures as transient synovitis.
- To emphasize the importance of thorough evaluation in limping children.
- To improve diagnostic accuracy for musculoskeletal injuries in toddlers.
Main Methods:
- Case series of three young children with tibial torus and toddler's fractures.
- Initial misdiagnosis of transient synovitis of the hip.
- Late diagnosis following initial presentation.
Main Results:
- Three Caucasian children (2 boys, 1 girl) aged 20 months to 3 years presented with symptoms initially attributed to transient synovitis.
- All three patients were ultimately diagnosed with tibial torus and toddler's fractures.
- Delayed diagnosis occurred due to the initial misinterpretation of symptoms.
Conclusions:
- Musculoskeletal trauma in non-cooperative children can be misdiagnosed as transient synovitis.
- This misdiagnosis can delay the identification of subtle fractures.
- Enhanced vigilance in the differential diagnosis of transient synovitis is crucial for young children.
Introduction:
The high incidence of transient synovitis in early childhood makes it the first suspected pathology in a limping child. Trauma, which has long been regarded as a causative factor for transient synovitis, may be underestimated in a non-cooperative toddler.After excluding most serious conditions, such as septic arthritis, a speculative diagnosis of transient synovitis can be made, and this can easily mask a subtle musculoskeletal injury.
Case Presentations:
We report the cases of three Caucasian patients (two boys, aged 20-months- and three-years-old, and one girl, aged two-years-old), with tibial torus and toddler's fractures which were late-diagnosed due to an initial misdiagnosis of transient synovitis of the hip.
Conclusion:
In a non-cooperative child musculoskeletal trauma can be mistaken as a simple causative factor for transient synovitis of the hip and this can easily prevent further investigation for a possible subtle musculoskeletal injury of the lower extremities.Our experience with the presented cases suggests the need to be more vigilant in the differential diagnosis of transient synovitis in young children.
