Pediatric orthopedic conditions: Clinical

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Pediatric orthopedic conditions: Clinical

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A 14-year-old boy comes to the pediatrician for evaluation of pain in multiple joints. The symptoms began 5 months ago. Joint pain initially started in the right knee but subsequently spread to the elbows and ankles. The symptoms are worse in the morning and improve after 1-2 hours of activity. Over the past several weeks, the patient has had a daily fever and an erythematous macular rash over his chest during the evenings. The patient lives with his parents in rural Maryland. Temperature is 37.9°C (100.2°F), blood pressure is 112/70 mmHg, and pulse is 62/min. Physical examination reveals mild swelling and tenderness to palpation in the bilateral elbows, knees, and ankles. Hyperemia of the uvea and mild pain with extraocular movement is noted in both eyes. Administration of which of the following medications is the next best step in management?  


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Pediatric bone pathologies typically cause pain, and it can vary in terms of intensity and radiation.

Pain usually involves the hip, knee, and back, and it usually worsens over time. If it involves one leg, the pain can lead to limping, and in some cases, individuals might not be able to bear weight.

The symptoms might be unilateral or bilateral, and they might worsen after physical effort and improve with rest. Arm pain is usually related to fractures or arm injuries secondary to trauma and an x-ray or CT of the arm is enough for diagnosis.

The conditions can be divided into those lead to hip pain which include developmental dysplasia of the hip, Legg-Calve-Perthes, slipped capital femoral epiphysis, and transient synovitis; those that cause knee pain, mostly represented by Osgood-Schlatter disease; and conditions that lead to back pain, usually congenital scoliosis.

First, developmental dysplasia of the hip or DDH is mostly associated with newborns, and it’s a spectrum of conditions that includes abnormal development of the acetabulum and proximal femur, and mechanical instability of the hip joint.

DDH results from laxity of the ligaments around the joint or from in utero positioning.

First, history might reveal associated risk factors like a positive family history of DDH, female gender, breech presentation at more than at 34 weeks of gestation, and tight lower extremity swaddling.

Physical examination might detect limited range of motion of the hips and legs, asymmetry of the limbs if only one side is affected, or asymmetric skin creases in the thigh and groin.

In those up to 6 months of age, DDH can be detected by the Barlow and Ortolani tests, which are also widely used as screening tests. The tests begin with the individual laying on their back on a stable surface with the hip flexed to 90° and in neutral rotation, which is when the limb is turned neither toward nor away from the body's midline.

During the Barlow test, the hip is then slightly adducted, which is when the thigh is brought towards the midline, while the examiner's hand is placed on the knee, directing the pressure posteriorly. The test is positive when a clunk indicates that the head of the femur is moving out of the acetabulum.


Pediatric orthopedic conditions refer to a group of disorders that affect the musculoskeletal system in children. Some examples include scoliosis, clubfoot, developmental hip dysplasia, and fractures. These conditions cause symptoms such as pain, limping, difficulty moving, and deformities. Treatment options vary depending on the specific condition and may include physical therapy, bracing, casting, and in some cases, surgery. Early detection and intervention can help to prevent complications and improve outcomes.


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