Module 56, General Orthopaedist Level
A nine year-old male with a diagnosis of spastic quadriplegic, cerebral
palsy presented for a follow-up exam. This patient was non-ambulatory and
non-verbal. Patient had good head control and was capable of sitting if
propped up. The patient had bilateral release of iliopsoas, gracilis, adductor
longus, distal hamstrings and right tensor facia lata release 4 weeks prior
to this examination. Now, the patient still required valium and analgesics
due to pain and muscle spasms. At this time a firm mass was palpated in
the left groin. The whole groin was warm to touch and the child was reported
to have intermittent temperature elevation to 38.5 degrees. He appetite
was also diminished. Two months post op the patient was still having pain.
Question 56A
Because
of the continuing pain the child should be placed in a cast for four weeks.
Question 56B
Further
work up is required with a bone scan.
Question 56C
A
erythrocyte sedimentation rate was found to be 45. Further work up is indicated
to rule out infection.
Question 56D
An
x-ray is obtained and is normal. Aspiration of the wound should be the
next step in the work up.
Question 56E
Daily
gentle range of motion exercise is to be encouraged at this stage in the
process.
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