CT without intravenous (IV) contrast can be useful in a few selected cases for preoperative planning after radiographs demonstrate a complex fracture [18]. MRI Lower Extremity There is no relevant literature regarding the use of MRI pelvis/hips to feet in the initial evaluation of acute limp with nonlocalized symptoms and no concern for infection. MRI is sensitive and specific for soft-tissue, cartilage, and bony pathology, including detection of stress reaction/fractures [19]. It may be performed in selected children when radiographs, clinical and imaging follow- up, and thorough physical examination fail to provide diagnostic clues about the source of symptoms. MRI Whole-Body There is no relevant literature regarding the use of whole-body MRI in the initial evaluation of acute limp with nonlocalized symptoms and no concern for infection. Because whole-body MRI is sensitive and specific for soft-tissue, joint, and bony pathology, and it allows for coverage of all musculoskeletal anatomy, it could play a role in localizing pathology in the limping child when the examination is nonfocal, the initial imaging workup is negative, and symptoms persist. Whole-body MRI has been shown to have more superior sensitivity than scintigraphic bone scans or radiography in detection of multifocal neoplastic lesions and chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis [20-22]. Whole-body MRI may be sensitive for detecting sites of involvement with inflammatory arthritides or osteonecrosis [23-25]. Variant 2: Child up to age 5. Acute limp. Pain. Localized symptoms. No concern for infection. Initial imaging. The body regions covered in this clinical scenario are: hip, femur, knee, tibia/fibula, ankle, and foot. Localized pain may be due to trauma, in which case it is important to exclude an underlying fracture. Clinical examination and history may allow localization of the pain or injury to a specific area, which allows a more focused imaging evaluation [26].
Acutely Limping Child Up To Age 5 PCAs. CT without intravenous (IV) contrast can be useful in a few selected cases for preoperative planning after radiographs demonstrate a complex fracture [18]. MRI Lower Extremity There is no relevant literature regarding the use of MRI pelvis/hips to feet in the initial evaluation of acute limp with nonlocalized symptoms and no concern for infection. MRI is sensitive and specific for soft-tissue, cartilage, and bony pathology, including detection of stress reaction/fractures [19]. It may be performed in selected children when radiographs, clinical and imaging follow- up, and thorough physical examination fail to provide diagnostic clues about the source of symptoms. MRI Whole-Body There is no relevant literature regarding the use of whole-body MRI in the initial evaluation of acute limp with nonlocalized symptoms and no concern for infection. Because whole-body MRI is sensitive and specific for soft-tissue, joint, and bony pathology, and it allows for coverage of all musculoskeletal anatomy, it could play a role in localizing pathology in the limping child when the examination is nonfocal, the initial imaging workup is negative, and symptoms persist. Whole-body MRI has been shown to have more superior sensitivity than scintigraphic bone scans or radiography in detection of multifocal neoplastic lesions and chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis [20-22]. Whole-body MRI may be sensitive for detecting sites of involvement with inflammatory arthritides or osteonecrosis [23-25]. Variant 2: Child up to age 5. Acute limp. Pain. Localized symptoms. No concern for infection. Initial imaging. The body regions covered in this clinical scenario are: hip, femur, knee, tibia/fibula, ankle, and foot. Localized pain may be due to trauma, in which case it is important to exclude an underlying fracture. Clinical examination and history may allow localization of the pain or injury to a specific area, which allows a more focused imaging evaluation [26].