Module 14, General Orthopaedist Level

This patient is a 14 year old boy who presented complaining of pain in his right leg for 9 months and a contracture of the right knee which has developed over this period. There is no history of significant trauma. Born 3 weeks premature with bilateral renal hypoplasia and a seizure disorder. Three renal transplants have failed and he currently receives peritoneal dialysis four times a day. Stunted growth and developmental delays during childhood include short stature, standing at 16 months and walking at 2 years. He sustained a right tibia and fibula fracture 6 years prior to presentation after minimal trauma. On physical examination he was noted to have poor dentitia, right knee 15 degree flexion contracture, painful ROM of right hip and knee.

Question 14A

The cause of his knee flexion contracture is the bending of the femur from the osteoporosis caused by the renal osteodystrophy.

Question 14B

This boy is probably also having secondary hyperparathyroidism.

Question 14C

All the bones are affected however the facial bones and skull are the only ones which are almost always asymptomatic.

Question 14D

Although the bones lack mineral, there may be calcification of the skin..

Question 14E

In children a with renal osteodystrophy, cupping of the metaphysis is a diagnostic finding.