0071643192.pdf

PEDIATRICS

SYMPTOMS/EXAM

■ Limp

■ Pain is usually in the groin or inner thigh; younger children can have diffi-

culty localizing the pain and may point to their knee.

■ Restricted motion of the hip, especially of internal rotation and abduction

DIAGNOSIS

AP and frog-leg lateral radiographs of the pelvis/hips

TREATMENT

■ Goal is to prevent subluxation of femoral head out of acetabulum.

■ Children <6 years of age without significant subluxation and at least

40–45 degrees of abduction can be observed.

■ Children >6 years old usually require containment with brace or surgery.

OSGOOD-SCHLATTER

■ Also known as osteochondritis of the tibial tuberosity

■ Overuse injury

■ Typical patient is a physically active teenage boy.

■ Results from repeated stress at the insertion of the patellar tendon onto the

tibial tuberosity

SYMPTOMS/EXAM

■ Tenderness at the insertion of the patellar tendon onto the tibial tubercle

■ Pain with climbing, jumping, or kneeling

■ Pain with resisted knee extension

DIAGNOSIS

Knee radiographs are usually normal, but may show soft-tissue swelling, irreg-

ularity, or prominence of tibial tubercle, and/or ossification anterior to the tib-

ial tubercle.

TREATMENT

Treatment includes restriction of activity, ice after activity, NSAIDs. In severe

cases, immobilization may be necessary.

SLIPPEDCAPITALFEMORALEPIPHYSIS(SCFE)

■ SCFE is displacement of the epiphyseal portion of the femoral head from

the metaphyseal/diaphyseal portion (through the physis). The epiphyseal

portion stays within the acetabulum, but is usually rotated medially and

posteriorly in relation to the metaphyseal portion.

■ Typical patient is an obese, African-American, adolescent male.

■ Other risk factors include hypothyroidism, growth hormone deficiency,

renal osteodystrophy.

SYMPTOMS/EXAM

■ Limp

■ Hip/groin pain common, but also may complain of pain localized to the

knee

■ Painful range of motion of hip, especially with internal rotation

Think of the femoral head as

an ice cream cone (the

epiphyseal portion is the “ice

cream”; metaphyseal and

diaphyseal portion is the

“cone”). The “ice cream”

usually stays within the socket

(acetabulum) and the “cone”

usually slips laterally and

anteriorly.

Young children often have

difficulty localizing pain.

Beware when children point to

their knee, as the true

pathology may actually be in

the hip!