Module 60, General Orthopaedist Level
The patient is an 8 year and 7 month old white male who reported that
he injured his left knee about two weeks ago when he fell off his bicycle.
The child complained of pain and swelling and difficulty moving his left
knee. He has been able to bear weight and ambulate with a limp. On ambulation
the left knee was held in mild flexion. The left knee lacked full range
of motion. Extension was approximately 10 degrees short of full. Flexion
was to approximately 120 degrees, about 20 degrees less than the opposite
side. There was a moderate effusion evident by blotting of the patella.
There were no specific areas of tenderness although ranging the knee was
bothersome with mild apprehension. No ligamentous instability was noted
during the exam. Exams of the hip and ankle were normal bilaterally as
was the right knee. AP, lateral and oblique radiographs of the left knee
showed an effusion with multiple radiodense bodies that were felt to be
intra-articular. No fractures or dislocations were evident.
Question 60A
Based
on this information the next part of the work up should include an MRI.
Question 60B
This is most consistent with the osteochondral fractures which occurred
during the bicycle accident.
Question 60C
At
arthroscopy inflamed synovium with rice sized pieces of cartilage were
found. The history and x-ray are consistent with this finding.
Question 60D
A
rheumatoid factor was obtained and found to be very positive. This is expected
based on the arthroscopy.
Question 60E
You
tell the family that is likely going to be a long term chronic process
with an uncertain outcome for the knee.
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