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Acute Care Casebook

Sarah Yale

, and David Mills


This case illustrates the approach to a pediatric patient who presents with a limp in the setting of fever. There are several “red flag” symptoms suggestive of more emergent diagnoses that are crucial to be mindful of when assessing a limping child. Applying the Kocher criteria can help to identify patients at higher risk of septic arthritis who require further diagnostic evaluation and acute management. In addition, obtaining a complete history including eliciting the timeline of presentation (acute versus chronic) and any pertinent preceding events such as recent viral illness or trauma is highly relevant. The case reviews the presentation of a patient with toxic synovitis and includes the basic diagnostic workup, the recommended treatment approach, and the expected timeline of improvement.

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