Pediatrics: hip pain

*1. What is the most common hip-related cause of limping and pain in children?
2. How is toxic synovitis of the hip diagnosed? How is it treated?
3. What is Legg-Calve-Perthes disease? What is the treatment and prognosis?
4. What is slipped capital femoral epiphysis? What population is it seen in?
5. What is the treatment of SCFE?

Answers:
1. Toxic synovitis.
2. Diagnosis is with limited IR of hip on exam, increased WBC and ESR, normal X-ray. Treatment is rest and NSAIDs, avoid full activity.
3. Avascular necrosis of the ossification center of the femoral head. Conservative treatment includes rest and abduction brace vs. varus osteotomy. There is a good prognosis if detected early with less than 50% femoral head involvement.
4. SCFE is separation of proximal femoral epiphysis through the growth plate, often seen in obese children, preadolescent/adolescent.
5. Treated with surgical pinning to prevent further epiphyseal displacement.