Radiography Lower Extremity Targeted radiographs of the areas of concern have a role in evaluating for possible fracture [12,26-29]. Negative radiographs do not completely exclude the possibility of a nondisplaced fracture. Dunbar et al [30] first described Acutely Limping Child Up To Age 5 Other causes of limp or pain, such as osteochondritis, apophysitis, osteonecrosis, or tumor, may be diagnosed with radiographs, though MRI has better sensitivity for such pathologies [31,32]. US Hips or Lower Extremity US has a limited field of view and has lower accuracy in detection of fractures as compared with radiographs. Weinberg et al [33] showed that clinician-performed US had a sensitivity and specificity of 73% and 92%, respectively, for the evaluation of fractures in children and young adults, with radiography or CT as the reference standard. 3-Phase Bone Scan Pelvis and Lower Extremity There is no relevant literature regarding the use of bone scan in the initial evaluation of acute limp with localized symptoms and no concern for infection. CT Lower Extremity There is no relevant literature regarding the use of CT in the initial evaluation of acute limp with localized symptoms and no concern for infection. CT without IV contrast can be useful in a few selected cases for preoperative planning after radiographs demonstrate a complex or intra-articular fracture [18]. MRI Lower Extremity There is no relevant literature regarding the use of MRI in the initial evaluation of acute limp with localized symptoms and no concern for infection. In children with persistent limp and negative radiographs, MRI is highly sensitive in detection of stress reaction/fractures [6]. When there are clinical signs of nonseptic arthritis, MRI is superior to both US and radiography in detecting inflammatory changes, early erosions, and cartilage thinning [34-37]. MRI should be performed when a tumor is suspected as it is sensitive for evaluation of bone marrow and soft-tissue extension [38].
Acutely Limping Child Up To Age 5 PCAs. Radiography Lower Extremity Targeted radiographs of the areas of concern have a role in evaluating for possible fracture [12,26-29]. Negative radiographs do not completely exclude the possibility of a nondisplaced fracture. Dunbar et al [30] first described Acutely Limping Child Up To Age 5 Other causes of limp or pain, such as osteochondritis, apophysitis, osteonecrosis, or tumor, may be diagnosed with radiographs, though MRI has better sensitivity for such pathologies [31,32]. US Hips or Lower Extremity US has a limited field of view and has lower accuracy in detection of fractures as compared with radiographs. Weinberg et al [33] showed that clinician-performed US had a sensitivity and specificity of 73% and 92%, respectively, for the evaluation of fractures in children and young adults, with radiography or CT as the reference standard. 3-Phase Bone Scan Pelvis and Lower Extremity There is no relevant literature regarding the use of bone scan in the initial evaluation of acute limp with localized symptoms and no concern for infection. CT Lower Extremity There is no relevant literature regarding the use of CT in the initial evaluation of acute limp with localized symptoms and no concern for infection. CT without IV contrast can be useful in a few selected cases for preoperative planning after radiographs demonstrate a complex or intra-articular fracture [18]. MRI Lower Extremity There is no relevant literature regarding the use of MRI in the initial evaluation of acute limp with localized symptoms and no concern for infection. In children with persistent limp and negative radiographs, MRI is highly sensitive in detection of stress reaction/fractures [6]. When there are clinical signs of nonseptic arthritis, MRI is superior to both US and radiography in detecting inflammatory changes, early erosions, and cartilage thinning [34-37]. MRI should be performed when a tumor is suspected as it is sensitive for evaluation of bone marrow and soft-tissue extension [38].