Differential diagnosis
- Septic arthritis – fever, red, swollen, warm joint
- DDH
- Toddle fracture – sudden twist or unwitnessed fall, tender over tibial shaft
- Non-accidental injury
- Transient synovitis – usually 4-8yo, may follow viral infection
- Perthes’ disease – usually 4-8yo, similar to synovitis but symptoms do not settle
- SUFE – usually >10yo, obese, boys, can be bilateral
- Referred pain
Data gathering
- Red flags – fever, systemically unwell
- Others – trauma, DDH risk factors, other joint problems
- Examine – temp, pGALS – Gait (+tiptoes and heels), Legs (hip, knee), Spine
Clinical management
- Investigations
- X-ray
- consider even for trivial trauma as children are more prone to subluxation or fracture
- USS / Bloods
- refer if considering
- X-ray
- Treatment
- Suspected transient synovitis
- If 3-9 years old, well, afebrile, mobile and limping less than 48hr
- Reassess after 48hr – if symptoms resolving, likely transient synovitis
- If symptoms fail to resolve after 7 days, consider referral
- If 3-9 years old, well, afebrile, mobile and limping less than 48hr
- Other causes
- Require secondary care input
- Suspected transient synovitis
- Followup / Safety-net
- Refer
- Child < 3 years old – transient synovitis is rare and septic arthritis/NAI more common
- Child > 9 years old with pain or restricted hip movement – to rule out SUFE
- Fever
- Systemically unwell
- Refer