Gangrenous Testicular Torsion, Presenting as Refusal to Bear Weight, in a Fourteen-Month-Old Child

Abstract

A limp is a symptom that frequently is presented to orthopaedic surgeons. The differential diagnosis is broad and varied. The orthopaedic surgeon is often consulted to “rule out” septic arthritis of the hip as well as other common orthopaedic conditions, including transient synovitis of the hip, osteomyelitis, discitis, and lower-extremity fracture. The differential diagnosis, however, is much more extensive and may include infrequently seen causes such as rheumatologic illness (juvenile rheumatoid arthritis or Lyme disease), neoplasm (leukemia or osteoid osteoma), or pelvic or abdominal pathology1. Determining the cause of a child's limp when the child will not bear weight on a lower extremity can be challenging. It is difficult, and often impossible, to obtain a reliable history from a young child, and parents may be poor historians or be unaware of incidents preceding presentation. We present the case of a fourteen-month-old boy with gangrenous testicular torsion who originally presented to the orthopaedic surgeon with refusal to bear weight on the left lower extremity and with presumed septic arthritis of the hip. The patient's parents were informed that data concerning the case would be submitted for publication, and they provided their consent. This case report is an example of how abdominal or genitourinary pathology can mimic septic arthritis of the hip. A fourteen-month-old boy was brought to the emergency department by his parents after he had abruptly stopped bearing weight on his left lower extremity that morning. They reported a three-day history of irritability and decreased appetite, but no history of trauma to the left lower extremity. An orthopaedic consult was requested to evaluate the child for possible septic arthritis of the left hip. The medical history was remarkable for undescended testes. He was born at term via cesarean section because of a breech position. Screening ultrasound shortly after …