Casebook: Childhood orthopaedic conditions

GP with paediatric specialism Dr David Capehorn discusses four orthopaedic presentations in children, advising on assessment, referral and management within primary care

Paediatric orthopaedic presentations are common in general practice and are a frequent source of parental anxiety. The majority of musculoskeletal problems seen in children are benign and self‑limiting, or represent normal variants of growth and development.
However, a small but important proportion reflect serious underlying pathology where early recognition, appropriate investigation and timely referral can be limb‑ or life‑saving.
This case-based module provides a structured, pragmatic framework for the assessment of some common childhood orthopaedic presentations, including examination techniques, age‑specific red flags and referral thresholds, drawing on current NICE and UK paediatric orthopaedic expert guidelines.

Learning objectives

This module will support and update knowledge of:

• How to assess a child or adolescent with suspected scoliosis, determining when imaging and urgent or routine referral are indicated.
• Assessment of infants for possible developmental dysplasia of the hip (DDH), identifying key risk factors and age-specific clinical signs, and appropriate imaging modality and referral urgency.
• Diagnosing and manage common causes of activity-related knee pain in adolescents, including making a confident clinical diagnosis of Osgood–Schlatter disease, advising evidence-based conservative management, and recognising features that should prompt investigation or urgent cancer referral.
• How to assess the limping child safely in primary care, differentiating transient synovitis from septic arthritis and applying principles of observation, investigation, safety-netting and referral.
• Identify age-specific ‘never-miss’ paediatric orthopaedic diagnoses, including early-onset scoliosis, developmental dysplasia of the hip (DDH), septic arthritis, slipped upper femoral epiphysis (SUFE) and bone malignancy, and initiate timely referral pathways to reduce the risk of limb- or life-threatening outcomes.

Author: Dr David Capehorn, GP with Specialist Interest in Paediatrics and Honorary Associate Specialist, Bristol Children’s Hospital. With thanks for helpful comments and editorial input from Mr Martin Gargan , Clinical Chair and Consultant Paediatric Orthopaedic and Trauma Surgeon, University Hospitals Bristol NHS Foundation Trust.

Module published: 26.02.2026