Module 46, General Orthopaedist Level
This patient is a 14 year old male weighting 105 kilograms. His systemic
exams were all within normal limits. He presents with a complaint of pain
in the knee which occurred after he slipped playing football. Examination
of his knee demonstrated full range of motion, no effusion, mild medial
joint line tenderness, and no ligament instability. Bilateral hips with
passive flexion to 75 degrees and abduction to 20 degrees on the left and
30 degrees on the right. Internal rotation was 0 degrees on the right and
-15 on the left with external rotation 70 degrees, bilaterally. Upper extremities
and bilateral feet exams were all within normal limits. He was initially
diagnosed with left SCFE and pinned in 12-93. He had been doing well but
then began unprotected weight bearing earlier than recommended. It was
noted that his left cannulated hip screw had cut out of the femoral head
and required removal in 2/94. The patient began to have right hip pain
in 3/94 during a period of crutch walking. It was noted at that time that
he also developed right sided SCFE.
Question 46A
With
cut out of the pin, he should just have the pin removed and be placed in
a spica cast.
Question 46B
Because
most children develop bilateral slipped epiphysis he should have had both
pinned at the first setting.
Question 46C
With
bilateral slips and this level of obesity you expect that he probably has
some hormonal imbalance.
Question 46D
The
natural history of the external rotation deformity at the femur is for
it to improve with time.
Question 46E
The
complaints of the knee in the initial presentation along with the physical
examination is very common.
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