Module 47, Pediatric Orthopaedic Level

1,2,3,4

A completely healthy and previously normal boy 10 years and 9 months old was noted by his parents to limp on the right side after a full day of activity. He also started to have a occasional hip pain. Since the hip pain became progressively worse, the family sought medical attention. At the first examination, abduction was 40 degrees bilaterally but internal rotation was limited to 0 degree on the right. The leg lengths were equal and no Trendelenburg sign was observed. X-ray showed the decreased epiphyseal height and medial joint opening. Snyder sling was started. At 12 years of age, internal rotation was still limited 20 degrees compared to 35 degrees on the left side but the left hip pain was asymptomatic. X-rays 1 and 2 were taken at the age of 11 years and 3 months and xray 3 was taken at 12 years of age. At 16 years of age, 10 degrees limitation of internal rotation as compared to the opposite side was still observed but the patient was asymptomatic. X-ray 4 was taken at 17 years of age.

Question 47A

This should be considered a good treatment outcome.

Question 47B

At age sixteen you tell him that he will probably have a good functioning hip until age 50 or 60.

Question 47C

This boy should be encouraged to seek a job which will not require him to spend long hours on his feet.

Question 47D

If he would present with pain, especially when he internally rotates his hip this would be a sign of early severe degenerative arthritis.

Question 47E

If he is presenting with pain at age 16 and the above x-ray, a hip arthroscopy is a good treatment option.

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