We presented a 5-year-old boy with fever, Limping, and hip pain for six days. There was no abnormal past medical history. He kept his left leg immobile and slightly flexed, and externally rotated in the hip joint. Laboratory findings showed leukocytosis and elevated ESR and CRP. Hip sonography was normal. Hip magnetic resonance imaging (MRI) found no joint effusion but elucidated signs of inflammation in muscles of the periarticular and proximal femoral area (iliopsoas and gluteus maximus), and no collection could be noticed. We provided a thorough discussion on differential diagnoses and approaches to the patient.

Limp is described as any deviation from a normal gait pattern for the child’s age. Limping takes many forms and is one of the most enigmatic complaints in pediatric medicine. It is never normal, and both benign and life-threatening illnesses can present with limp. The provisional diagnosis can be a challenge to establish even after history, physical, and laboratory examinations.

A 6-year-old old girl presented with left femoral pain and Limping for about 3 week’s duration. Plain X-ray of the femoral bone and a bone scan are shown in Figures 1 and 2. What is your differential diagnosis. ...

Background & Aim: Patient-centered care is considered a pivotal element of the mission of the healthcare system around the world. However implementing Patient-centered care is not always easy and nurses have admitted this fact reluctantly. The evidence suggests that the first step in implementing Patient-centered care is to change the professionals' viewpoint, behavior, and understanding. This study examined nurses' perceptions of the components of Patient-centered care and its delivery. Methods & Materials: This was qualitative descriptive research with a conventional content analysis approach. Face-to-face interviews were conducted with 21 nurses, working in teaching hospitals in Tabriz, Iran, and 5 field notes were collected. Data were analyzed using the Zhang and Wildemuth method of content analysis. Results: Three main themes and eleven sub-themes were extracted. Nurses identified "Effective Communication", "Careful Care of Distinctive Needs", and "Valuing the Patients and Their Rights" as the main elements of Patient-centered care. Conclusion: Nurses implement some components of Patient-centered care. Yet Patient-centered care remains an ad hoc practice requiring more improvement. This study provided a deeper understanding of nurses' perceptions about the implementation of Patient-centered care and their weaknesses. The finding is consistent with current knowledge, shedding light on Patient-centered care-related practices performed by Iranian nurses and pointing to areas for improvement in implementing Patient-centered care.

Gait disturbance is a common presentation of neurologic disease in children. Limping is a kind of gait dysfunction that occurs due to neurologic & skeletal diseases. Diskitis is an inflammatory process noted as one of the significant causes of Limping especially in children aged less than 3 yr. Here we report case of diskitis and Limping as the significant manifestation of Gait disturbance in A 22 months old boy from 17 Shahrivar Hospital in 2016, Rasht, northern Iran. Regarding normal neurologic exam, nervous system involvement was less possible. About 60% of gait cycle related to stance phase.

Background: Limping is a common complaint of children presenting to the emergency departments of hospitals,therefore, it is important to identify its causes and avoid unnecessary measures. In this study, common etiologies for Limping in children presenting to the emergency department of Pediatric Hospital of Amirkola in Babol, Iran were evaluated. Methods: All children under 15 years of age presented to the emergency department of Pediatric Hospital of Amirkola, during 2017-2018, with complaints of acute Limping were retrospectively evaluated. Initially, 71 patients were found among whom 53 were selected based on inclusion and exclusion criteria of the study. The census method was used to obtain the required samples. Patient information including demographic data, clinical signs, and symptoms at admission were gathered. Statistical analysis was done using SPSS v22 software (IBM, USA), and p<0. 05 was considered statistically significant. Results: Of 53 children, 33 (62. 3%) were boys and 20 (37. 7%) were girls. The mean age of participants was 4. 53±, 2. 79 years old, and the mean length of hospital stay was 10. 5±, 7. 2 days. Inflammation and infections were the most common etiologies with a cumulative prevalence of 58. 49 and 28. 30%, respectively. Transient synovitis was the most common differential diagnosis with a prevalence of 43. 4%, and the most affected joints were hips with a prevalence of 73. 5% (p-values=0. 001). Conclusion: Most of the diseases for acute Limping in children are self-limited, but this should not lead to disregard for infection as a differential diagnosis.

This report presents a 3.5-year-old boy who was hospitalized for Limping. Medical history and physical exams were not suggestive for any definitive diagnosis. Laboratory and radiographic exams did not support any specific diagnosis either. Subsequently bone scan was performed and increased activity in the ankle due to cuboid fracture was incidentally observed.

Unicameral bone cysts (UBCs) are benign, osteolytic lesions which are often asymptomatic and are commonly seen in the proximal of humerus and femur. The average age at diagnosis is 9-11 years and there is a male preponderance with a male-to-female ratio of approximately 2-2.5 to 1. We describe a case of 5-year-old girl who presented to orthopedic clinic with a 4-month history of painful Limping. Plain radiography of the right knee demonstrated a well-defined lytic lesion in the proximal of the tibia. Open biopsy and then curettage and bone grafting with bone- substitute was performed. The diagnosis of this condition requires a high index of suspicion. This report demonstrates that all UBCs do not have the same clinical patterns and with adequate attention good results can be achieved.

Background: Limping is a common complaint in childhood, accounting for 4 per 1000 visits in one pediatric emergency department. Limping is caused by benign and/ or life-threatening conditions such as (infectious, inflammatory, neoplasm, mechanical and orthopedic causes). Osteoid osteoma is a relatively common benign tumor of bone that can present with a Limping. The femur is the most common site of occurrence. Although osteoid osteoma is seen in all age groups, 70% of cases occur in individuals<20 years of age. Osteoid osteoma occurs twice as commonly in boys as in girls. The pain typically is nocturnal and aching, and responds briskly to NSAIDs therapy. The lesion may be visible as a lucency with a dense central nidus on plain radiographs or CT scan, or it may be apparent only on bone scan or MRI.Case Presentation: Since 2010, five patients (4 boys and 1 girl) were referred to a rheumatology clinic in Children’s Medical Center, Tehran, Iran with history of Limping. The mean age of patients was 11 years. The most location of tumor was the neck of femur (4 patients) and in only 1 case, it was in proximal of tibia. All of them had history of a dull aching pain for weeks to months, which was worse at night and was relieved by aspirin or nonsteroidal antiinflammatory drugs. Two cases were treated with NSAIDS medications. One case had operative treatment and 3 cases were treated with radiofrequency ablation under CT guide (after incomplete response to NSAIDS) with complete relief of pain up to now, without any complication. Conclusion: Radiofrequency ablation can be considered as a safe treatment in osteoid osteoma in children.

When a happy six-year-old boy comes to your clinic with complaints of pain in his right hip after activity and his parents say their son has Limping, which important disease should not be missed? The answer is the Legg-Calvé-Perthes disease (LCPD). This pediatric orthopaedic condition corresponds to an avascular necrosis of the proximal capital femoral epiphysis (1). Arthur T. Legg, Jacques Calvé , and Georg Perthes were the first to describe the disease in 1910 (2) and after 110 years, causes of the disease are still unclear...