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Diagnosing and managing hip problems in childhood.
[pyomyositis]
The
hip
and
proximate
tissues
are
implicated
in
a
variety
of
childhood
conditions
,
and
in
the
differential
diagnosis
of
many
more
.
To
a
large
extent
the
possible
diagnoses
are
limited
by
the
child
's
age
,
an
accurate
history
and
thorough
examination
.
Developmental
dysplasia
of
the
hip
(
DDH
)
is
a
spectrum
disorder
of
joint
development
and
/
or
instability
.
It
is
a
major
cause
of
morbidity
in
children
and
adults
.
It
can
be
classified
into
three
types
:
neuromuscular
;
teratological
;
and
idiopathic
(
the
most
common
type
)
.
Examination
of
the
hips
is
carried
out
neonatally
using
Ortolani
and
Barlow
manoeuvres
to
look
for
dislocation
.
These
tests
have
high
sensitivity
but
low
specificity
,
and
this
is
one
reason
why
DDH
is
still
picked
up
late
.
When
a
limping
child
presents
it
is
important
that
the
less
common
diagnoses
,
including
infection
,
neoplasia
and
slipped
femoral
epiphysis
are
kept
in
mind
and
urgent
referral
made
if
necessary
.
In
one
study
,
where
a
diagnosis
was
made
,
the
hip
joint
was
the
culprit
in
the
majority
of
cases
.
Of
these
,
40
%
were
diagnosed
as
irritable
hip
or
transient
synovitis
.
Other
inflammatory
arthritides
/
tendinoses
accounted
for
3
.
2
%
,
Perthes
'
disease
2
%
,
and
infection
3
.
6
%
.
Any
age
group
is
vulnerable
to
infection
such
as
septic
arthritis
,
osteomyelitis
and
pelvic
pyomyositis
.
Early
diagnosis
and
treatment
,
comprising
antibiotics
with
or
without
surgery
,
is
critical
.
In
the
limping
child
,
fever
with
focal
tenderness
or
restricted
range
of
movement
is
indicative
of
infection
unless
investigations
show
otherwise
.
Diseases
Validation
Diseases presenting
"including infection"
symptom
pyomyositis
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