Pediatric Knees

[brainfailure]

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So while moonlighting, I had this girl last night, 5 yrs old got her knee caught in the Merry Go Round at school and hurt it. She had a small effusion, some joint line tenderness, but most importantly she could not extend her knee it all. She wanted to keep it at 0 degrees (like bent under her thigh), I slowly tried to help her extend it but after I got to 90+ she started crying and said it hurt.
I couldn't really do a Lachman's/McMurray, but ant/post drawer were normal. XR showed no fracture or loose body or anything. It seemed like some soft tissue knee thing, but not a quad tendon/patellar tendon rupture. More likely a meniscal injury.

Anyways, I couldn't get her knee to extend, and it's pissing me off. I couldn't get a knee immobilizer on her, so I put her in an ACE bandage. Fortunately, I got her into a Peds Ortho Clinic for this afternoon. What the heck am I missing? I feel like there's something obvious I should have done and I'm just not thinking of it.

Any ideas?

 

[RxnMan]

The three things my ortho attendings pounded into my head as a student rotator:

1) Always get an x-ray of the joint above and the joint below a fracture/displacement/etc.

2) Always include an axillay or Y view when evaulating whether a shoulder was properly reduced or not.

3) In peds, knee pain = hip disease until proven otherwise.