Acutely Limping Child Up To Age 5 If initial imaging is normal but symptoms persist, follow-up radiographs or radiographs of areas besides the tibia/fibula may be useful. In the Baron et al study [13], approximately 10% of tibial fractures were only visible on follow-up radiographs and not initial imaging. One patient, who was discharged, later returned with worsening symptoms and signs of infection and was found to have spinal discitis and epidural abscess. As these examples illustrate, if the initial evaluation is negative and symptoms persist or worsen, a follow-up clinical reassessment and further imaging evaluation may be necessary. US Hips or Lower Extremity There is no relevant literature regarding the use of ultrasound (US) in the initial evaluation of acute limp with nonlocalized symptoms and no concern for infection. US is sensitive in evaluation of joint effusions and soft-tissue fluid collections; however, the typical field of view is small, limiting the role of US when symptoms and clinical evaluation cannot localize the site of pathology [14]. Because pain that is due to hip pathology can be referred elsewhere in the lower extremity, such as the thigh, knee, or buttock [15], US of the hip could be considered if initial radiographs are negative and symptoms persist. 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 nonlocalized symptoms and no concern for infection. Scintigraphic bone scan is sensitive in detecting bone pathology and could have a role in localizing the pathology in limping children when the examination is nonfocal, radiographs are negative, and symptoms persist [1,10,16,17]. However, a bone scan lacks specificity in this clinical scenario [1,10,16]. CT Lower Extremity There is no relevant literature regarding the use of CT in the initial evaluation of acute limp with nonlocalized symptoms and no concern for infection.
Acutely Limping Child Up To Age 5 PCAs. Acutely Limping Child Up To Age 5 If initial imaging is normal but symptoms persist, follow-up radiographs or radiographs of areas besides the tibia/fibula may be useful. In the Baron et al study [13], approximately 10% of tibial fractures were only visible on follow-up radiographs and not initial imaging. One patient, who was discharged, later returned with worsening symptoms and signs of infection and was found to have spinal discitis and epidural abscess. As these examples illustrate, if the initial evaluation is negative and symptoms persist or worsen, a follow-up clinical reassessment and further imaging evaluation may be necessary. US Hips or Lower Extremity There is no relevant literature regarding the use of ultrasound (US) in the initial evaluation of acute limp with nonlocalized symptoms and no concern for infection. US is sensitive in evaluation of joint effusions and soft-tissue fluid collections; however, the typical field of view is small, limiting the role of US when symptoms and clinical evaluation cannot localize the site of pathology [14]. Because pain that is due to hip pathology can be referred elsewhere in the lower extremity, such as the thigh, knee, or buttock [15], US of the hip could be considered if initial radiographs are negative and symptoms persist. 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 nonlocalized symptoms and no concern for infection. Scintigraphic bone scan is sensitive in detecting bone pathology and could have a role in localizing the pathology in limping children when the examination is nonfocal, radiographs are negative, and symptoms persist [1,10,16,17]. However, a bone scan lacks specificity in this clinical scenario [1,10,16]. CT Lower Extremity There is no relevant literature regarding the use of CT in the initial evaluation of acute limp with nonlocalized symptoms and no concern for infection.