Board Review

By No Means Bored Review

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A made up patient walks into Dr. Sally Bogoch’s fictitious Hospital (the aptly named “Bogoch General”).

6 year old male is brought in by ambulance for limping for 7 weeks. ROS neg, VS wnl. PE: He has no bony tenderness or pain on range of motion to his knee, but does have decreased abduction and internal rotation of his hip.

Didn't we do this last week?

No silly, the patient is a different age, so the board answer is different. Though in real life you would likely have both diagnosis on your differential

 

This diagnosis?

Legg Calve Perthes Disease

 

Classic presentation?

age 5-7 (but can occur from 2-13), also male predominance, 10% have bilat pathology, usually insidious in onset

 

Pathophysiology?

 Repeated episodes of femoral head ischemia (of unknown etiology) result in infarction and necrosis. Eventually, sub-chondral stress fractures occurs leading to flattening of the femoral head. End game: hip subluxation with contractures and decreased range of motion. 

 

Diagnose by?

Hip/pelvis xray with frogleg view. Can be very subtle initially such as widening of the cartilage space or increased density of the femoral head. The above mentioned sub-chondral fracture (Caffey sign) is followed by destruction/deformation of the femoral head (coxa plana). MRI or bone scan can diagnose earlier.

 

Treatment/Dispo?

Non-emergent Ortho referral. Minimal weight bearing with brace or surgery to keep femoral head abducted/internally rotated

 

Should you now probably review the last post to cement the difference between these two hip diseases of children?

Yes, of course!

 

By Dr. Andrew Grock and Dr. Sally Bogoch

 

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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