Pediatric emergency medicine trisk 0905 0905

proximal tibia, both classically affecting young adolescents. Osteochondrosis can
involve the foot bones in three locations: The tarsal navicular bone (Kohler
disease) in younger children and the metatarsal heads (Freiberg disease) or the
calcaneal apophysitis (Sever disease) in adolescents. Both benign and malignant
bone tumors may present with a painful limp. Benign lesions include bone cysts
(unicameral or aneurysmal), fibrous dysplasia, and eosinophilic granulomas.
Osteoid osteoma, caused by a painful nidus of vascular osteoid tissue, is another
benign lesion unique to young people. The most common malignant pediatric
bone tumors are osteogenic sarcoma and Ewing sarcoma. Bone tumor pain may
be acute or chronic, with acute pain usually related to a pathologic fracture.
Examples of acquired skeletal abnormalities causing painful limp include tarsal
coalition and osteochondritis dissecans. Tarsal coalition occurs as a result of
gradual calcification of a congenital cartilaginous bar between tarsal bones; it
presents most commonly as a painful flatfoot in school-aged children.
Osteochondritis dissecans is related to osteonecrosis of the subchondral bone with
separation of articular cartilage from underlying bony lesion; it most commonly
affects the knees of adolescent boys.
Localized findings without pain suggest congenital or slowly developing
acquired limb abnormalities. Three disorders of the hip fit into this category, each
of which is characteristic of a specific age group. Developmental dysplasia of the
hip includes a spectrum of abnormalities, ranging from mild dysplasia to frank
dislocation. Most affected children with access to primary care are diagnosed
with abnormal hip abduction on routine examination in infancy. Occasionally, the
diagnosis will be missed, and the child then presents at the onset of walking with
a painless short-leg limp, or waddling gait if bilateral, with weakness of the
abductor musculature. Legg–Calvé–Perthes disease, an avascular necrosis of the
capital femoral epiphysis, presents in young school-age children as an insidious
limp with mild, activity-related pain. Slipped capital femoral epiphysis (SCFE)
presents in young, typically obese adolescents with an externally rotated limp.
The amount of pain experienced is related to the rate of displacement of the
epiphysis, ranging from none to severe. Legg–Calvé–Perthes disease and SCFE

are more common in boys. Other acquired skeletal deformities that may cause
painless limp include limb-length inequality, Blount disease (with marked bowing
of the proximal tibias), and torsional deformities. Baker cyst of the popliteal
tendon may cause limping with minimal local discomfort.