A 3 year old boy presents to the Emergency Department with a limp. He has been reluctant to weight bear on his right leg during the day and has a temperature of 37.9°C. Hip examination is painful. What clinical or laboratory tests could help discriminate between septic arthritis and transient synovitis?

Of course, you could just ring up orthopaedics and ask them to take him to theatre and wash out the hip - but you may not win many friends that way. How do you decide there is enough ‘clinical suspicion’ to make the call? more…

Do infants born with an isolated clubfoot (talipes equinovarus) require radiological investigations to rule out congenital hip dysplasia?
You are a neonatal SHO. The midwife asks you to see a term baby who has just been born. She has noticed the baby to have a clubfoot and wants you to examine the baby.Physical examination confirms a clubfoot and there are no other abnormalities. Both hips are stable on clinical examination using the Ortolani and Barlow’s test.

Your registrar asks you to request a hip ultrasound or hip X-ray for this baby to rule out DDH. You are not used to this practice and decide to appraise the evidence behind it. more…