374.A 2-year-old boy is brought to the ED by his parents stating that he is
limping. The mother states that he was fine yesterday but woke up today
and would not bear weight. He had a normal active day yesterday with no
notable falls. On examination, the patient is in mild distress. His vital signs
are a temperature of 101°F, HR 120 beats per minute, RR 24 breaths per
minute, blood pressure (BP) 90/55 mm Hg. He has mild nasal congestion.
He is able to move his left lower extremity only a small amount and has dis-
comfort with range of motion of his left hip. He is unable to bear weight.
There is no swelling, rash, warmth, or erythema. White blood cell (WBC),
C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) are all
normal. Radiograph of the hips bilaterally and left femur and knee are all
negative. After high dose ibuprofen in the ED, the patient is able to bear
weight. What is the most appropriate management of this patient?
a. Admit for IV antibiotics.
b. Consult orthopedics after ultrasound for aspiration of hip in the operating
room (OR).
c. Bone scan to evaluate for osteomyelitis.
d. Nonsteroidal anti-inflammatory drugs (NSAIDs) and reassurance to parents
with follow-up in 24 hours.
e. Splint leg for treatment of occult fracture through growth plate than can not be
visualized on initial x-rays.
402 Emergency Medicine