Module 33, Pediatric Orthopaedist Level
An 11 year old boy presented with a one year history of right knee
pain. He stated that his knee recently "gave way" when running
down the stairs at school. He described his discomfort as a deep achy pain
on the medial aspect of his knee. There was no history of trauma, nor had
the pain limited his activities until recently. The boy denied numbness,
paresthesias or weakness in his right leg. He had no fevers, chills, and
any recent illnesses. Examination revealed an obese adolescent male in
no acute distress. Height is 149cm(50%) Weight is 59 Kg (>95%). The
right knee appeared atraumatic without any areas of point tenderness. There
was diffuse pain in the knee with passive ROM. No effusion was present
in the knee. An xray of the knee was obtained and found to be normal. Hip
x-rays are above.
Question 33A
The
patient should be immediately scheduled for surgery.
Question 33B
Following
the surgery the child should be non-weight bearing for 3 months.
Question 33C
At
the time of the original surgery the boy should have had both hips pinned
since they very commonly go on to have bilateral slips.
Question 33D
If
this boys left hip is to develop a slip it will usually happen with in
3 months of the first slip.
Question 33E
Occult
slips are common in the hip unaffected hip of the child with a reported
unilateral SCFE.
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