Skip to main content
WardSpace
Pediatric cases

Refusing to walk since breakfast

A 4-year-old woke up limping and now will not put his right foot down. He had a cold last week. His mother thinks he hurt himself in the garden.

Age4 yearsWeight17.0 kg

Pediatrics

4 years old· preschool17.0 kgboy, Pediatric emergency, room 5Fictitious educational patient
Caregiver
Mother: 'He had a runny nose last week, nothing much. This morning he was limping and by lunch he would not walk at all. He says his knee hurts. He was warm this afternoon, 38.5 at home.'
Immunizations
Up to date.
Development
Normal.
Previously well

Day 0 · 16:30

The child who will not walk

He is on the bed with his right hip held flexed, abducted and externally rotated. He cries when you approach the leg. He points to his knee.

Vitals

HR132high for ageBP98/62RR24SpO298%T38.7high for age

Read against the preschool band (3 to 5 years): HR 80 to 120 awake, RR 20 to 28, hypotension below 76 systolic at the youngest age in the band. Fever, crying and pain move these numbers.

Examination

  • Gait: Refuses to weight-bear on the right.
  • Hip: Held in flexion, abduction and external rotation; marked pain on any internal rotation; log roll painful.
  • Knee: Normal range, no effusion, no warmth.
  • Other joints and spine: Normal. No rash. No bruising.

He points to his knee. Where is the problem, and what is the first differential?

Answer the question above to continue.