The limping child

An 11 month old boy attends the emergency department with his mother. He doesn’t want to crawl, and his mother has noticed his right leg looks deformed and he cries when it is touched. He has an X-ray which shows a spiral fracture of his right femur. The radiologist calls you up to say that they think he has an old fracture of his tibia. His mother tells you there is no history of trauma, but that he’s looked after by several different friends and family members so she’s not always with him. What would be the best course of action?

A four year old attends the emergency department with a limp. You take a history from him. Which of the following are red flags in the history suggesting he needs further investigation?

A 6 year old boy has an 8 hour history of worsening of left hip and thigh pain. He was previously fit and well apart from a cold a week ago. There is no history of joint problems or trauma. He refuses to weight bear and is very distressed with attempted examination of his hip. His temperature is 38.5degrees and he looks flushed. Heart rate is 120bpm. Systemic examination was normal and examination of other joints is normal. Initial investigations showed: WCC 15, CRP 30, ESR 60, normal blood film, X-ray of the hips – normal, USS hips – hip effusion. Which of the following are true?