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  • Dr. Paul Dhillon MB BCh CCFP

Helpful Mnemonic for Pediatric Limps


SHORT ANSWER MANAGEMENT POP QUIZ:

- What is the most common causative organism in paediatric osteomyelitis?

- What patient populations are at higher risk for SCFE?

- What is the best haematological test for septic arthritis of the hip?

(Answers are in the blog post below.)

Every time a concerned parent brings a child with a limp in to see me in clinic or the emergency department I say ‘progressive idiopathic avascular necrosis of the femoral head’ under my breath because it just rolls off the tongue so easily. Not. This is an area that is rife with risk and a missed diagnosis. A recent article in Annals of EM has a great way to remember the diagnoses that you can’t miss!

So think about LIMPSS in real life and on the exam:

L: Legg-Calve-Perthes disease

I: Infection/Inflamation (Most common organism for pediatric osteomyelitis is Staphylococcus aureus)

M: Malignancies (Ewing’s Sarcoma and Osteosarcoma)

P: Pain from a fracture (Could it be abuse? Is my patient safe?)

S: Slipped Capital Femoral Epiphysis (overweight teens, boys, Black patients & Hispanic patients are at higher risk)

S: Something else above? If your MSK exam is leaving you standing on one leg without a clue of what is going on, think about referred pain from above OR below. Yes, everyone reminds you about the knee, but don’t forget about what is sitting deep in that abdomen…is it an ectopic, a psoas abscess, or an appendix?

Phew. Now that you have that mnemonic you’re ready for any child that LIMPSS into your SOO or SAMP and you won’t miss the can’t-miss diagnosis.

Almost forgot! For those of you still wondering what (probably) is the best blood test for septic arthritis of the hip in children it is a CRP > 2.0 mg/dl.

Study hard and hope to see some of you at The Review Course!

References

Limping Child? Think LIMPSS. Raam, Ryan et al. Annals of Emergency Medicine, Volume 67 , Issue 2 , 297 – 300.

Caird MS, Flynn JM, Leung YL, et al. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. 2006;88:1251-1257.

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