Websites on hip pain in childhood

Dr Keith Barnard recommends websites relating to painful hip conditions in childhood.

WEBSITE OF THE WEEK
This site has all the characteristics of a good all-rounder. There are tables and plenty of X-rays that allow you to get an overall picture of slipped capital femoral epiphysis. The classification and demographics are discussed, then the article moves on to deal with signs and assessment.

What makes this article stand out is the section on radiological diagnosis. There are half a dozen X-rays that show degrees of displacement, diagnostic signs and post-treatment images. The paragraph on prognosis is useful, because it will help you deal with parental anxieties. The outcome is not always rosy, so you will be able to prepare yourself for dealing with an unfavourable outcome.

Why go there: covers the ground well.
Downside: none.
Information from: American Academy of Family Physicians.
Address: www.aafp.org/afp/980501ap/

PERTHES' DISEASE
Here we go all the way to Brazil to find a decent site on Perthes' disease, also known as Legg-Calve-Perthes disease.

All the key information about epidemiology, presentation and treatment are here. All you have to do is forgive the odd spelling mistake that presumably occurred in translation. The section that particularly impressed me was the series of X-rays that show the evolution of Perthes' disease in a six-year-old child over a two-year period.

Why go there: adequate, brief information.
Downside: Poorly presented.
Information from: Medcenter Solutions of Brazil.
Address: Please click here

AGE DIFFERENTIATION
There is often something helpful to find on this website, which, although aimed at surgeons, presents its material in a straightforward way that can be useful to GPs. The section on hip pain in children is a prime example. It starts with a diagnostic calendar of childhood hip disorders, and this approach is worth the visit alone. It divides the age range from zero to age 15 into five-yearly intervals, and lists the most common forms of hip disorder in each age range. Most of the rest of the site is devoted to Perthes' disease, and there are some decent X-rays to look at.

Why go there: there is an excellent age-related differential diagnosis list.
Downside: not enough detail on all the possibilities.
Information from: www.surgical-tutor.org
Address: Please click here

TRANSIENT SYNOVITIS
Transient synovitis is what we old 'uns used to call an irritable hip, and it was quite an education to read some of the stuff out there about it. Obviously the most important thing to do is rule out septic arthritis but, once that has been done, I thought it was just a case of rest.

That certainly isn't the way in the USA, where it seems practitioners are urged to throw the book at them, do every investigation known to man and then offer traction as a treatment.

Why go there: brief summary of an important diagnosis of exclusion.
Downside: poor presentation.
Information from: Wheeless' Textbook of Orthopaedics.
Address: www.wheelessonline.com/ortho/transient_synovitis

SEPTIC ARTHRITIS
This is the big bad wolf of hip pain in childhood and, of all the sites out there about it, this was the only account I found that began with the vital words 'Septic arthritis is a medical emergency'. Once you've seen a child's joint destroyed by this condition in a couple of days, you tend not to forget this important fact. This site does not confine itself to the hip, or to childhood, but it is comprehensive without bludgeoning you into unconsciousness with an overload of minutiae.

Why go there: a must-visit site.
Downside: none.
Information from: British Society for Antimicrobial Chemotherapy.
Address: Please click here

Dr Barnard is a former GP in Fareham, Hampshire.

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