Module 62, General Orthopaedist Level

A 10 year old white female was evaluated in the orthopaedic clinic for leg length discrepancy. Her disease process has been characterized by early breast development at 3 years of age, menarche at the age of 6, and a pathologic subtrochanteric fracture after a trivial fall at age 8. She now complains of a limp and pain after long walks. The patient demonstrated a large pigmented lesion with irregular border located in the right upper back. There was a two centimeter leg length discrepancy by the block test.

Question 62A

This history and x-rays demonstrate simple fibrous dysplasia.

Question 62B

The Cafe-au-lait spots, which are the light brown hyper-pigmented macular skin lesions, have an irregular border. This suggests neurofibromatosis

Question 62C

A bone scan would be expected to have no areas of increased uptake and be cold.

Question 62D

CT scan can be used to differentiate between fibrous dysplasia and eosinophilic granuloma.

Question 62E

Gradual varus deformity of the proximal femur may occur during the teenage years.

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