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Difficulty: MediumOrthopedic Surgery

Match the following pediatric orthopedic conditions with their most characteristic clinical presentation and diagnostic findings.

  • Slipped capital femoral epiphysisA 13-year-old boy with a BMI at the 95th percentile presenting with an atraumatic limp and dull thigh pain; examination reveals limited internal rotation of the hip.
  • Legg-Calvé-Perthes diseaseA 6-year-old boy presenting with a chronic, insidious limp and mild anterior thigh pain; radiographs demonstrate a flattened, sclerotic, and fragmented proximal femoral epiphysis.
  • Transient synovitisA 5-year-old boy presenting with acute onset of hip pain and refusal to bear weight 10 days after a mild upper respiratory tract infection; inflammatory markers are mildly elevated.
  • Osgood-Schlatter diseaseA 14-year-old girl who plays travel soccer presenting with localized anterior knee pain; physical examination reveals a prominent, tender tibial tubercle.

Answer

Slipped capital femoral epiphysis matches the obese 13-year-old boy with limited internal rotation; Legg-Calvé-Perthes disease matches the 6-year-old boy with a fragmented femoral head; Transient synovitis matches the 5-year-old boy with post-viral acute hip pain; Osgood-Schlatter disease matches the 14-year-old soccer player with a tender tibial tubercle.
Each pediatric orthopedic condition has a highly stereotyped clinical vignette on the USMLE. SCFE is recognized by the obese adolescent with hip/knee pain and altered hip rotation. Legg-Calvé-Perthes is identified by the younger child with an insidious limp and characteristic radiographic fragmentation of the femoral head. Transient synovitis is marked by acute, post-viral hip pain without severe systemic toxicity. Osgood-Schlatter is distinguished by anterior knee pain localized to the tibial tubercle in a physically active adolescent.

Step-by-Step Solution

1
Analyze the age and body habitus for the hip pathologies.
The 13-year-old obese boy fits an adolescent demographic, while the 6-year-old and 5-year-old represent younger childhood demographics.
SCFE is strongly associated with obesity and the adolescent growth spurt, distinguishing it from conditions affecting younger children.
2
Differentiate the two early childhood hip presentations.
The 6-year-old has a chronic, insidious limp with radiographic fragmentation (Legg-Calvé-Perthes), whereas the 5-year-old has an acute onset following a viral illness (Transient synovitis).
Legg-Calvé-Perthes is an avascular necrosis process taking months to develop, while transient synovitis is an acute, reactive inflammatory response.
3
Identify the knee pathology based on anatomic location and activity.
The 14-year-old soccer player with a tender tibial tubercle perfectly matches Osgood-Schlatter disease.
Osgood-Schlatter is a traction apophysitis specifically located at the tibial tubercle, exacerbated by jumping and running.

Key Concept

Clinical differentiation of pediatric lower extremity pathologies based on patient age, acuity of symptom onset, and specific physical examination or radiographic findings.
Estimated Time:1m 30s
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Orthopedic Surgery

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