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Hip pain in children:
The definition of hip pain requires careful examination of the child and parents, the search for lameness, a precise loco-regional and general examination.
- Its location: generally near the groin;
- Its irradiation, which is most often done towards the knee;
- Its mode of onset: brutal or progressive, marked by a refusal of support, impotence;
- The schedule of pain: daytime, mechanical, occurring during loading, or at night, interfering with sleep.
The gait examination looks for lameness caused by bearing pain.
The loco-regional physical examination looks for a non-painful position in external rotation, swelling of the soft parts, a painful awakening on palpation, a limitation of passive and active mobility, in particular in internal rotation and abduction.
The general physical examination includes an examination of the various devices and the search for accompanying signs: fever, deterioration of the general condition.
Hip pain: newborn or infant hip pain
In newborns or infants, the demonstration of hip pain is the result of a careful, systematic, and repeated examination which will highlight a pseudo paralysis in the newborn after a difficult delivery or a syndrome. infectious sometimes discreet, associated with pseudo-paralysis in infants due to two different causes.
Epiphyseal fracture of the upper extremity of the femur
In the newborn after a difficult delivery, the existence of a pseudo-paralysis should require an x-ray. This immediately allows the diagnosis of fracture-detachment of the upper end of the femur to be made.
The prognosis is generally good after treatment with immobilization.
Infant osteoarthritis
In infants, it is most often the existence of an infectious syndrome with the deterioration of the general condition that gives the alert. This infectious syndrome can be discreet and it is then the existence of a pseudo paralysis that leads to the examination. This shows swelling of the soft parts of the hip and thigh. One should not wait for the appearance of a displacement of the head of the femur on the standard radiograph to consider the diagnosis.
The presence of an effusion on ultrasound should very quickly lead to the treatment of this arthritis by puncture, repeated if necessary, or arthrotomy, adapted antibiotic treatment, immobilization in a cast.
Sequelae of inequality in the length of the lower limbs, growth disorders, or joint destruction are indeed frequent.
Hip pain: where does it come from in children?
The search for an origin often guided by the age of the child is based on the results of the questioning, the clinical examination, and the para-clinical examinations. A normal x-ray should not overdiagnose a hip cold. In an evocative context, other examinations are necessary to make an early diagnosis. Some causes are indeed a therapeutic emergency.
Hip cold
In children aged 3 to 10 years, hip pain with lameness that occurs after inflammation or infection can be diagnosed as a hip cold. Examination of the child’s hip will show an effusion of joint fluid, which causes limitation of internal rotation and hip abduction.
The evolution is done with the disappearance of the signs in eight days after the putting rest of the joint.
Primary osteochondritis or Legg-Perthes-Calvé disease
Gradually onset marked by hip pain sometimes reported to the knee or lameness, it preferentially affects boys between 3 and 12 years old. Legg-Perthes-Calvé disease causes difficulty in hip rotation. It is scintigraphy or MRI that allows the diagnosis.
Lameness is caused by massive and rapid degradation of the growing cartilage; bone involvement which can even go as far as necrosis of the femur’s head.
The treatment of primary osteochondritis consists of either total rest or surgery (osteotomy).
Femoral neck fracture
Occurring in obvious traumatic circumstances, they require surgical treatment and expose to a risk of necrosis by lesion of the vascularization of the femoral head.
Hip pain: where does it come from in adolescents?
There are several possible conditions. Here are the most common:
Epiphysis of the upper end of the femur
It is a sliding of the femoral head on the growth cartilage. It results in the inability to walk due to pain in the hip, groin crease, or even knee.
On the lateral x-ray:
- We can see the tilt of the femoral head that we can measure (the angle between the axis of the neck and the perpendicular to the base of the growth cartilage is normally 0 °);
- This is a therapeutic emergency requiring a three-month ban on support accompanied by screwing of the femoral head. The progress of recovery is all the more favorable when the displacement is minimal; we then understand the need for early diagnosis.
Apophysitis and osteochondrosis
It is an attack of tendon insertions linked to athletic overwork that can go as far as tearing. Palpation of the tendon insertion and tensioning by upset contraction of the muscle group concerned makes it possible to localize the damage which is, in general, to the tendons of the muscles of the pelvis.
Hip arthritis
It is marked by the appearance of hip pain with lameness associated with an infectious syndrome. The infection may be masked by antibiotic treatment without prior diagnosis.
The puncture, after the ultrasound shows the presence of an effusion, allows the diagnosis.
We should not wait for the appearance of radiographic signs with a displacement of the femoral head. This is a therapeutic emergency that will require evacuation and cleaning of the joint by repeated punctures, total rest, immobilization, and appropriate antibiotic treatment.