Module 27, Pediatric Orthopaedist Level
This is a 3 year old girl who presented to the emergency room with
a complaint of left foot pain exacerbated by bearing weight. The previous
day the patient's 4 year old sister had jumped onto her left foot during
play resulting in immediate pain and an antalgic gait. She had no pain
in the left foot prior to this episode. She was evaluated and radiographs
were obtained. The radiology report said this was consistent with Kohler's
disease and no fractures were noted. The parents were told by their family
doctor that this will go away on its own and no treatment is indicated.
After she continued to limp for four weeks the family obtained another
opinion. An x-ray was obtained demonstrating acute periosteal reaction
in the middle three metatarsals.
Question 27A
This
suggests that this was an occult fracture from the episode occurring at
play.
Question 27B
The
type of treatment makes no difference to the long term out come of Kohler's
disease.
Question 27C
The
tarsal navicular is not ossified in children by age three.
Question 27D
During
the initial formation of the tarsal navicular there is usually only one
artery supplying the bone.
Question 27E
Kohler's
disease is more common in boys.
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