Module 47, General Orthopaedic Level

1,2,3,

A completely healthy and previously normal boy 10 years and 9 months old was noted by his parents to limp on the right side after a full day of activity. He also started to have a occasional hip pain. Since the hip pain became progressively worse, the family sought medical attention. At the first examination, abduction was 40 degrees bilaterally but internal rotation was limited to 0 degree on the right. The leg lengths were equal and no Trendelenburg sign was observed. X-ray showed the decreased epiphyseal height and medial joint opening. Snyder sling was started. At 12 years of age, internal rotation was still limited 20 degrees compared to 35 degrees on the left side but the left hip pain was asymptomatic. X-rays 1 and 2 were taken at the age of 11 years and 3 months and xray 3 was taken at 12 years of age.

Question 47A

At this age treatment can be discontinued.

Question 47B

The Snyder sling is a form of containment treatment.

Question 47C

A varus osteotomy would have yielded a better outcome than the Snyder sling.

Question 47D

Based on the appearance of his x-rays at age 12 you would be very optimist to the parents that he will have a well functioning hip into adulthood.

Question 47E

Osteochondritis dissecans can develop in a hip with Perthes disease.