Board Review

Almost, But Not Quite Bored Review

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A patient presents to Andy’s stupid fictional (but HIPAA compliant) hospital.

He is an overweight 11 year old male who complains of hip pain and limp since minor fall 2 weeks ago. ROS o/w neg. VS wnl. PE with externally rotated leg with pain on abduction, flexion, and internal rotation.

Diagnosis?

SCFE! (slipped capital femoral epiphysis)

 

Classic presentation?

age 10-16, male predominance, obese, endocrine disorder, 15-25% have bilat pathology, can have mild trauma but many are insidious in onset

 

Diagnose by?

Hip/pelvis xray with frogleg view important. Can be subtle such as mild widening of metaphysis. check out Klien’s line here or Shelton’s line here. If high suspicion, some recommend MRI.

 

Treatment/dispo?

immediate ortho consult for surgery. Some orthopods recommend bilateral pinning. Must be nonweight bearing as untreated can lead to avascular necrosis, !

 

Wasn't this fun and informative?

Yes, of course!

 

Wasn't there another leg thingy in kids that's on the inservice a lot?

Glad you asked…wait until next week!

 

By Dr. Andrew Grock and Sally (or “slappy”?) Bogoch per here

 

References

Tintinalli’s, 7th ed

The Atlas of Emergency Radiology

Atlas of Pediatric Emergency Medicine, 2nd edition

Emergency Orthopedics, 6th ed

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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andygrock

  • Resident Editor In Chief of blog.clinicalmonster.com.
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  • Resident at Kings County Hospital