Hip Pain in Children
Ayla Yagdiran1, Kourosh Zarghooni, Jörg Oliver Semler
1Department of Orthopedics and Trauma Surgery, University Hospital Cologne; Department of Pediatrics, University Hospital Cologne.
Insights
Prompt diagnosis of pediatric hip pain is crucial. Early identification of causes like coxitis or Perthes disease prevents long-term complications in children.
Area of Science:
- Pediatric Orthopedics
- Pediatric Rheumatology
Background:
- Pediatric hip pain is a common clinical presentation, affecting 148 per 100,000 individuals annually.
- It presents a diagnostic challenge for pediatricians, orthopedists, and general practitioners.
Purpose of the Study:
- To review the differential diagnosis and diagnostic approaches for atraumatic hip pain in children.
- To emphasize the importance of early diagnosis for preventing adverse outcomes.
Main Methods:
- A selective literature search was conducted in the PubMed database up to April 2019.
- Included publications comprised case reports and review articles.
Main Results:
- Infants may present with purulent coxitis, diagnosed via blood tests and ultrasonography.
- Older children exhibit painful hip restriction, limping, or inability to walk; differential diagnoses include transient synovitis and Legg-Calvé-Perthes disease.
- Adolescents may have slipped capital femoral epiphysis (SCFE); bone tumors and rheumatic diseases are also considered.
- Initial diagnostics involve X-rays and ultrasound; CT or MRI are indicated for suspected tumors.
Conclusions:
- Timely diagnosis of the underlying cause of pediatric hip pain is essential.
- Early intervention can mitigate long-term sequelae and improve patient outcomes.
Background:
Atraumatic hip pain in children is one of the most common symptoms with which pediatricians, orthopedists, and general practitioners are confronted, with an incidence of 148 cases per 100 000 persons per year.
Methods:
This article is based on publications up to April 2019 that were retrieved by a selective search in the PubMed data- base, including case reports and reviews.
Results:
Infants with fever often have purulent coxitis, which can be diagnosed by blood tests and ultrasonography. Toddlers and older children may suffer from painful restriction of motion of the hip joint, associated with limping (antalgic gait) or even the in- ability to walk. The main elements of the differential diagnosis in children aged 2-10 are coxitis fugax and idiopathic necrosis of the femoral head (Perthes disease). In children aged 10 and up, and in adolescents, slipped capital femoral epiphysis (SCFE) is typical. Bone tumors and rheumatic diseases must always be considered as well. The initial diagnostic steps on presentation of a child with restricted hip movement should be plain x-rays and joint ultrasonography for the detection of an effusion. Suspicion of a tumor is the main indication for tomographic imaging (computed tomography or magnetic resonance imaging).
Conclusion:
The underlying cause of hip pain in children should be diagnosed early to avoid adverse sequelae.
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