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Cristaldi S, Boni A, Ferro V, Musolino A, Della Vecchia N, Boccuzzi E, Bellelli E, Biagiarelli FS, Aulisa AG, Cirillo M, Raucci U, Villani A. Atraumatic Limping Child, a Challenge for Pediatricians: An Observational Age-Related Study in a Pediatric Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2024; 11:185. [PMID: 38397297 PMCID: PMC10887381 DOI: 10.3390/children11020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Atraumatic limping is a frequent cause of consultation in Pediatric Emergency Departments (PED) and often represents a challenge for pediatricians for its variability in etiology ranging from benign causes to potential crippling conditions. The aims of this research are to illustrate the clinical features of acute limping children (LC) and to identify the possible red flags that could help to make a diagnosis of severe pathologies. METHODS We carried out a retrospective study about non-traumatic limping children referred to the PED of Bambino Gesù Children's Hospital over a 2-year period. We divided the cohort into three groups based on the patient's age: toddlers, children and adolescents. We considered crippling conditions: oncologic etiologies, bone or neurological infections, epiphysiolysis, Perthes disease, Guillain Barrè syndrome and non-accidental injuries. RESULTS We analyzed 485 patients. At clinical evaluation, 19.5% of the patients presented at least one sign and/or symptom of red flags. Crippling conditions (6.2% of the total population) showed red flags in 36.7%. Transient synovitis of the hip was the most frequent diagnosis. We found crippling conditions in 30 patients, mostly represented by toddlers. CONCLUSIONS Our data suggest that toddlers and patients presenting red flags should be evaluated with particular suspicion because they have an increased risk of underlying severe conditions.
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Affiliation(s)
- Sebastian Cristaldi
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Alessandra Boni
- Pneumology and Cystic Fibrosis, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Valentina Ferro
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Nicoletta Della Vecchia
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Elena Boccuzzi
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Elena Bellelli
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Francesco Saverio Biagiarelli
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Angelo Gabriele Aulisa
- Orthopaedics and Traumatology Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marco Cirillo
- Department of Radiology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Umberto Raucci
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
| | - Alberto Villani
- General Pediatrics and ED 2nd Level, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.C.); (V.F.); (N.D.V.); (E.B.); (E.B.); (F.S.B.); (A.V.)
- Systems Medicine Department, University of Rome Tor Vergata, 00133 Rome, Italy
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Lin J, Wang Y, Sha J, Li Y, Fan Z, Lei W, Yan Y. Clinical reliability and validity of a video-based markerless gait evaluation method. Front Pediatr 2023; 11:1331176. [PMID: 38188911 PMCID: PMC10771829 DOI: 10.3389/fped.2023.1331176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To explore the reliability and validity of gait parameters obtained from gait assessment system software employing a human posture estimation algorithm based on markerless videos of children walking in clinical practice. Methods Eighteen typical developmental (TD) children and ten children with developmental dysplasia of the hip (DDH) were recruited to walk along a designated sidewalk at a comfortable walking speed. A 3-dimensional gait analysis (3D GA) and a 2-dimensional markerless (2D ML) gait evaluation system were used to extract the gait kinematics parameters twice at an interval of 2 h. Results The two measurements of the children's kinematic gait parameters revealed no significant differences (P > 0.05). Intra-class correlation coefficients (ICC) were generally high (ICC >0.7), showing moderate to good relative reliability. The standard error of measurement (SEM) values of all gait parameters measured by the two walks were 1.26°-2.91°. The system software had good to excellent validity compared to the 3D GA, with ICC values between 0.835 and 0.957 and SEM values of 0.87°-1.71° for the gait parameters measured by both methods. The Bland-Altman plot analysis indicated no significant systematic errors. Conclusions The feasibility of the markerless gait assessment method using the human posture estimation-based algorithm may provide reliable and valid gait analysis results for practical clinical applications.
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Affiliation(s)
- Jincong Lin
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Yongtao Wang
- School of Telecommunications Engineering, Xidian University, Xi’an, China
- Guangzhou Institute, Xidian University, Xi’an, China
| | - Jia Sha
- Department of Orthopaedics, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yi Li
- School of Telecommunications Engineering, Xidian University, Xi’an, China
- Guangzhou Institute, Xidian University, Xi’an, China
| | - Zongzhi Fan
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Wei Lei
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Yabo Yan
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
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Wijtzes N, Jacob H, Knight K, Thust S, Hann G. Fifteen-minute consultation: The toddler's fracture. Arch Dis Child Educ Pract Ed 2021; 106:94-99. [PMID: 32817067 DOI: 10.1136/archdischild-2020-319758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 11/04/2022]
Abstract
The toddler's fracture is a distinct entity among tibial shaft fractures. It is defined as a minimally displaced or undisplaced spiral fracture, usually affecting the distal shaft of the tibia, with an intact fibula. They are often difficult to diagnose due to the absence of witnessed trauma and because initial radiographs may appear normal. Moreover, the presenting complaint (a non-weight bearing child) has a wide differential diagnosis. A detailed history and examination, together with additional imaging and other investigations, is crucial to diagnose a toddler's fracture. Analgesia and immobilisation are the mainstays of treatment, with follow-up in fracture clinic recommended. Inflicted injury (Note: this article will use the term inflicted injury which is also called non-accidental injury. In the field of safeguarding, there is a move away from using the term 'non-accidental injury' due to misinterpretation of the term as being less serious than 'abusive injury' and that in child protection reports the term can be easily misread or mistyped as 'accidental' injury) should always be considered when red flags for child abuse are present. In this article, we aim to cover the differential diagnoses for toddler's fracture including indicators that might suggest an inflicted injury.
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Affiliation(s)
- Nils Wijtzes
- Department of Paediatrics, North Middlesex University Hospital, London, UK
| | - Hannah Jacob
- Department of Paediatrics, North Middlesex University Hospital, London, UK
| | - Katie Knight
- Paediatric Emergency Medicine, North Middlesex University Hospital, London, UK
| | - Steffi Thust
- Radiology, University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, UK
| | - Gayle Hann
- Department of Paediatrics, North Middlesex University Hospital, London, UK
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Thompson M, Johnson T, Koberlein G. Radiologic Evaluation of the Child with a Limp. Pediatr Ann 2020; 49:e395-e402. [PMID: 32929515 DOI: 10.3928/19382359-20200821-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A child presenting with a limp can present a diagnostic challenge to pediatricians. Clinical presentation, age, and history all contribute to the initial differential diagnosis; however, imaging plays a key role in the ultimate diagnosis, and the correct imaging study is essential to save time and health care expenses. This article will present a few of the more common causes of a limp and the recently updated imaging recommendations from the American College of Radiology to aid in final diagnosis. [Pediatr Ann. 2020;49(9):e395-e402.].
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