Slipped capital femoral epiphysis : Obese adolescent male, referred pain to knee usually present, loss of abduction and internal rotation of hip. Tmt: surgical pinning promptly to avoid avascular necrosis.
Legg-Calve-Perthes disease: child 4-10yrs, male, avascular necrosis of femoral head, idiopathic. Tmt- splint or surgery
Septic arthritis: Emergency. Acute onset, warm swollen jt, hematogenous spread following URTI, staph & strep,
hip is externally rotated, X ray usually normal, wbc count is high, ESR is high.
Do USS guided aspiration- synovial fluid leucocyte >100,000 is definitely SA, do culture.
Tmt : drain immediately, empirical antibiotics nafcillin (or vancomycin ) + cephalosporin
Avascular necrosis in sickle cell anemia: African descent, history suggestive of SS
Transient synovitis: male child 3-10yrs, following trauma or viral infection.
Exclude septic arthritis. if at least 3 of the following are present, do further workup.
ESR >40 ,
Refusal to bear weight