Module 46, THE ALFRED I. DUPONT INSTITUTE

Module 46, Pediatric Orthopaedist Level

This patient is a 14 year old male weighting 105 kilograms. His systemic exams were all within normal limits. He presents with a complaint of pain in the knee which occurred after he slipped playing football. Examination of his knee demonstrated full range of motion, no effusion, mild medial joint line tenderness, and no ligament instability. Bilateral hips with passive flexion to 75 degrees and abduction to 20 degrees on the left and 30 degrees on the right. Internal rotation was 0 degrees on the right and -15 on the left with external rotation 70 degrees, bilaterally. Upper extremities and bilateral feet exams were all within normal limits. He was initially diagnosed with left SCFE and pinned in 12/93. He had been doing well but then began unprotected weight bearing earlier than recommended. It was noted that his left cannulated hip screw had cut out of the femoral head and required removal in 2/94. The patient began to have right hip pain in 3/94 during a period of crutch walking. It was noted at that time that he also developed right sided SCFE. The x-rays over the next year showed evidence of left femoral head osteonecrosis with collapse of the anterior and superior aspect of the head. He was walking with external foot progression angle and complaining of pain in the hip.

Question 46A

The best way to deal with this situation is to maintain the patient on crutches with toe touch weight bearing.

Question 46B

The Femoral head spin osteotomy (Sugioka) would be the best osteotomy to consider in this type of situation.

Question 46C

A base of the femoral neck osteotomy is another reasonable option for correcting this deformity.

Question 46D

The Southwick osteotomy was designed for the treatment of this condition.

Question 46E

The main concern of the base of the neck osteotomy (Abraham) is that it is intracapsular and risks injury to the vessels.

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