Related Experiment Videos
Evaluation of acute gait abnormalities in preschool children
1Orthopedic Department, Naval Hospital Portsmouth, Virginia.
Insights
In children under 5 with limps, normal inflammatory markers (CBC, ESR, temperature) rarely indicate infection. Bone scans are valuable for diagnosing various pediatric bone and joint conditions.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Diagnostic Imaging
Background:
- Limping in children under 5 is a common presentation requiring prompt diagnosis.
- Differentiating infectious etiologies from other causes of limp is critical.
Purpose of the Study:
- To evaluate the diagnostic utility of clinical findings and investigations in children under 5 presenting with new onset limp or refusal to bear weight.
- To determine the accuracy of inflammatory markers, radiography, aspiration, and bone scintigraphy in diagnosing pediatric hip and knee pathology.
Main Methods:
- Retrospective chart review of 60 children under 5 hospitalized for limp or refusal to bear weight.
- Analysis of complete blood count (CBC), erythrocyte sedimentation rate (ESR), temperature, radiographs, joint aspiration, and bone scans.
Main Results:
- Only 1 of 22 patients with normal CBC, ESR, and temperature had an infection.
- Joint aspiration identified 9 of 13 infections.
- Bone scans led to definitive diagnoses in 18 of 35 cases, identifying conditions like osteomyelitis, Perthes disease, JRA, fractures, and discitis.
Conclusions:
- Normal inflammatory markers (CBC, ESR, temperature) are highly predictive of a non-infectious etiology in children under 5 with limp.
- Joint aspiration and bone scintigraphy are superior to radiography in diagnosing the cause of limp in this age group.
Abstract:
The charts of 60 consecutive children aged less than 5 years hospitalized for evaluation of a new onset limp or refusal to bear weight were reviewed. Only 1 of 22 patients with a normal complete blood count (CBC), erythrocyte sedimentation rate (ESR), and temperature had an infection. Of the 14 patients with a diagnosis of infection, only one had a normal CBC, ESR, and temperature. Radiographs were diagnostic in only four cases, whereas aspiration identified nine of 13 infections. Thirty-five bone scans were performed; 18 led to a definitive diagnosis including synovitis osteomyelitis, Perthes disease, juvenile rheumatoid arthritis, (JRA), fracture, soft tissue infection, and discitis.