Paediatric Fractures & the Limping Child
Account for growth plates, developmental stage and childhood musculoskeletal emergencies.
Quick revision ↓ Medical Dictionary
01Children are different
Growing bone can buckle or bend incompletely, and the growth plate may be injured. Remodelling potential depends on age, site and deformity; rotation may not correct acceptably. Do not apply adult fracture rules automatically, and arrange appropriate paediatric review for injuries that may affect growth.
02Growth-plate injury
Assess tenderness and mechanism even when initial imaging is subtle. Physeal injury can cause growth disturbance, so classification must be linked to a follow-up plan. Explain uncertainty and warning signs to carers rather than promising that every childhood deformity will straighten spontaneously.
03Supracondylar injury
Elbow injury in a child requires careful vascular and nerve assessment. A poorly perfused hand is an emergency, and a warm but pulseless hand still needs urgent specialist evaluation through the paediatric pathway. Document median, anterior interosseous, radial and ulnar function where assessable before and after treatment.
04The limping child
Assess age, fever, pain, weight-bearing and hip movement while considering referred pain. Septic arthritis is an emergency, and absence of fever does not exclude every infection. A child unable to bear weight or with persistent unexplained symptoms needs assessment beyond a casual diagnosis of transient synovitis.
05Adolescent hip and safeguarding
Hip disease can present as knee pain. Suspected slipped upper femoral epiphysis needs protected non-weight-bearing and urgent orthopaedic review. Consider safeguarding when injury history is incompatible with developmental ability, documenting facts and following the local pathway without unsupported conclusions.
High-Yield Revision
- Growth-plate injuries may need longer follow-up.
- Hip pathology can present as knee pain.
- A warm pulseless hand is not a routine discharge finding.
Common Pitfalls
- Assuming all deformity will remodel.
- Diagnosing a limp without examining the hip.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.