Module 14, Pediatric Orthopaedist Level

This patient is a 14 year old boy who presented complaining of pain in his right leg for 9 months and a contracture of the right knee which has developed over this period. There is no history of significant trauma. Born 3 weeks premature with bilateral renal hypoplasia and a seizure disorder. Three renal transplants have failed and he currently receives peritoneal dialysis four times a day. Stunted growth and developmental delays during childhood include short stature, standing at 16 months and walking at 2 years. He sustained a right tibia and fibula fracture 6 years prior to presentation after minimal trauma. On physical examination he was noted to have poor dentitia, right knee 15 degree flexion contracture, painful ROM of right hip and knee.

Question 14A

Distal phalanges and clavicles are good sites to monitor the response to treatment.

Question 14B

The Rugger Jersy spine is caused by vertebral body decalcification.

Question 14C

The lucent metaphyseal bands are the best indicators secondary hyperparathyroidism.

Question 14D

The recommended treatment for the bowing of the femur is to immediately do an osteotomy before it gets worse.

Question 14E

If the child is developing a mild slipped femoral epiphysis, maximum medical management is the treatment to initiate.