Examkin

Soru

Zorluk: OrtaOrthopedic Surgery

A 13-year-old boy is brought to the clinic by his parents due to left knee pain and a limp that has progressively worsened over the past month. Yesterday, the pain became significantly more severe after he jumped down from a small wall. He has no history of direct trauma to the knee, fever, or prior medical conditions. His BMI is 34 kg/m234 \text{ kg/m}^2. Vital signs are within normal limits. Physical examination of the left knee reveals no effusion, joint line tenderness, or ligamentous laxity. During examination of the left hip, flexion of the hip results in obligatory external rotation of the thigh. Internal rotation of the left hip is severely limited and elicits pain. Radiographs of the hip confirm the diagnosis. Which of the following is the most appropriate next step in management?

  1. Strict non-weight bearing and operative stabilizationCevap
  2. B
    Reassurance, rest, and scheduled ibuprofen
  3. C
    Magnetic resonance imaging of the left knee
  4. D
    Closed reduction and application of a spica cast
  5. E
    Urgent ultrasound-guided arthrocentesis of the left hip

Cevap

Strict non-weight bearing and operative stabilization
The patient's presentation of a limp, referred knee pain, obesity, and obligatory external rotation of the thigh during hip flexion is highly characteristic of a slipped capital femoral epiphysis (SCFE). In SCFE, the proximal femoral epiphysis slips posteriorly and inferiorly relative to the femoral neck. Because the condition can rapidly progress and lead to avascular necrosis of the femoral head, the immediate next step in management is to ensure the patient is strictly non-weight bearing and to consult orthopedics for surgical stabilization (typically percutaneous pinning in situ).

Adım Adım Çözüm

1
Analyze the physical examination findings to localize the source of the pain.
The knee exam is entirely normal, while the hip exam shows limited internal rotation and obligatory external rotation upon flexion.
Knee pain in an adolescent can often be referred from the hip due to shared innervation by the obturator nerve. A normal knee exam necessitates a careful hip evaluation.
2
Integrate the demographic data and localized hip pathology to form a diagnosis.
An obese 13-year-old male with chronic hip/referred knee pain and altered hip mechanics has Slipped Capital Femoral Epiphysis (SCFE).
SCFE classically presents in overweight adolescents undergoing rapid growth spurts, resulting in the proximal femoral epiphysis slipping posteriorly and inferiorly.
3
Determine the definitive management for the diagnosed condition.
The most appropriate next step is strict non-weight bearing and surgical fixation.
SCFE is an orthopedic emergency because further slippage can compromise the blood supply to the femoral head, leading to avascular necrosis. Immediate surgical pinning in situ is required.

Anahtar Kavram

Diagnosis and management of Slipped Capital Femoral Epiphysis (SCFE)
Tahmini Süre:1m 15s
Bu soruyu puanla

Konular

Orthopedic Surgery

Bu konudan daha fazla soru