Obese 12-year-old boy (87 kg). He has been complaining of mechanical pain in the right thigh and knee for 4 months. Clinical examination reveals a 1 cm discrepancy in the length of the lower extremities and an attitude of the right lower extremity in external rotation with loss of internal rotation. We should suspect that he presents:
We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation. This picture should automatically lead us to mark epiphysiolysis capitis femoris (proximal femoral epiphysiolysis, the fact of reading it in Latin nomina is a bit of a misunderstanding but it should not mislead us). We should think of this one because it is the most frequent and possible (correct answer 2). The other options are not impossible but they are less frequent and they would not ask us this if they wanted us to choose another option. If they were sequelae of hip dysplasia, it would not have this 4-month onset and the age of onset would be earlier. Complications of dysplasia are dislocations and subluxations that may require surgery and avascular necrosis of the head (false answer 5). Perthes disease occurs in younger children (4-9 years) with episodes of limping and pain in the hip and knee (false answer 4). In a child the most typical would be a fracture at the level of the physis, not at the level of the femoral neck, so we discard 3. For us to consider this option we would have to have been presented with a bone cyst, something that would justify a weakness in the femoral neck area. As for juvenile chronic arthritis, it is a rheumatoid option surrounded by trauma options. They do not speak to us of rheumatologic factors in an analytical analysis, nor of a polyarticular picture. Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false). In addition, the knee pain in this case refers to a referred pain of the hip, without involvement of the knee.
Juvenile chronic arthritis.
Epiphysiolysis capitis femoris.
Fracture of the femoral neck due to overload.
Perthes disease.
Sequelae of developmental dysplasia of the hip.
Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false).
We should think of this one because it is the most frequent and possible (correct answer 2).
In a child the most typical would be a fracture at the level of the physis, not at the level of the femoral neck, so we discard 3.
Perthes disease occurs in younger children (4-9 years) with episodes of limping and pain in the hip and knee (false answer 4).
Complications of dysplasia are dislocations and subluxations that may require surgery and avascular necrosis of the head (false answer 5).