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Zorluk: OrtaPediatric Musculoskeletal Disorders

A 5-year-old boy is brought to the pediatrician by his parents because he has been limping since yesterday morning. The parents report that he had a mild upper respiratory tract infection about one week ago, which resolved without treatment. He refuses to bear full weight on his right leg but is able to walk with a noticeable limp. His temperature is 37.4°C (99.3°F), blood pressure is 95/60 mm Hg, pulse is 98/min, and respirations are 20/min. Physical examination shows no erythema or swelling of the lower extremities. There is full range of motion of the right knee and ankle. However, internal rotation and abduction of the right hip elicit discomfort. Laboratory studies show:

Leukocyte count: 7,500/mm37,500/\text{mm}^3
Erythrocyte sedimentation rate: 15 mm/h15 \text{ mm/h}
C-reactive protein: 0.5 mg/dL0.5 \text{ mg/dL}

Radiographs of the right hip and pelvis are unremarkable. Which of the following is the most appropriate next step in management for this patient?

  1. Administration of ibuprofen and outpatient observationCevap
  2. B
    Intravenous administration of ceftriaxone and vancomycin
  3. C
    Magnetic resonance imaging of the right hip
  4. D
    Surgical pinning of the right femoral head
  5. E
    Ultrasound-guided arthrocentesis of the right hip

Cevap

Administration of ibuprofen and outpatient observation
The correct option identifies the standard of care for transient synovitis, which consists of supportive treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and observation. This patient's clinical presentation—a young child with acute hip pain following a viral infection, accompanied by normal inflammatory markers and absent fever—strongly points to this benign condition.

Adım Adım Çözüm

1
Evaluate the patient's demographic and clinical presentation.
A 5-year-old boy presents with an acute limp, right hip pain with internal rotation, and a history of a recent viral upper respiratory infection.
Identifying the timeline and preceding events helps differentiate infectious from reactive etiologies.
2
Assess the Kocher criteria for septic arthritis.
The patient has 0 out of 4 criteria: no fever > 38.5°C, bears partial weight, normal WBC count (< 12,000/mm^3), and normal ESR (< 40 mm/h).
The Kocher criteria stratify the risk of septic arthritis versus transient synovitis.
3
Determine the appropriate therapeutic next step.
The most likely diagnosis is transient synovitis, which is managed conservatively with NSAIDs and observation.
Because the probability of septic arthritis is extremely low, invasive procedures and advanced imaging are not indicated.

Anahtar Kavram

Transient synovitis is a benign, self-limiting condition that typically follows a viral illness in children aged 3-8 years; it is managed conservatively with NSAIDs when Kocher criteria for septic arthritis are negative.
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Pediatric Musculoskeletal Disorders

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