Almost, But Not Quite Bored Review

Published by andygrock on

A patient presents to Andy’s stupid fictional (but HIPAA compliant) hospital.

He is an overweight 11 year old male who complains of hip pain and limp since minor fall 2 weeks ago. ROS o/w neg. VS wnl. PE with externally rotated leg with pain on abduction, flexion, and internal rotation.

Diagnosis?

SCFE! (slipped capital femoral epiphysis)

 

Classic presentation?

age 10-16, male predominance, obese, endocrine disorder, 15-25% have bilat pathology, can have mild trauma but many are insidious in onset

 

Diagnose by?

Hip/pelvis xray with frogleg view important. Can be subtle such as mild widening of metaphysis. check out Klien’s line here or Shelton’s line here. If high suspicion, some recommend MRI.

 

Treatment/dispo?

immediate ortho consult for surgery. Some orthopods recommend bilateral pinning. Must be nonweight bearing as untreated can lead to avascular necrosis, !

 

Wasn't this fun and informative?

Yes, of course!

 

Wasn't there another leg thingy in kids that's on the inservice a lot?

Glad you asked…wait until next week!

 

By Dr. Andrew Grock and Sally (or “slappy”?) Bogoch per here

 

References

Tintinalli’s, 7th ed

The Atlas of Emergency Radiology

Atlas of Pediatric Emergency Medicine, 2nd edition

Emergency Orthopedics, 6th ed

The following two tabs change content below.

andygrock

Latest posts by andygrock (see all)

Categories: EM Principles

0 Comments

Leave a Reply

Avatar placeholder

Your email address will not be published. Required fields are marked *

Related Posts

EM Principles Obstetrics/Gynecology

Can I Order a Preeclamptic for Delivery, Please?

Author: Harry Nonez, MD Edited by: Nicole Anthony, MD You are a senior resident working in the critical care area of a busy ED. You are juggling eight patients, and the triage nurse pulls you Read more…

EM Principles Evidence-Based Medicine Pharmacology

Emergency Department Management of Dyspnea in the Dying Patient

Authors: Taylor Douglas; Naomi Rebollo Rodriguez Edited by: Nicole Anthony; Wesley Chan Many patients present to the Emergency Department (ED) with the chief complaint of shortness of breath. There are myriad causes and extensive treatments Read more…

EM Principles Endocrinology

Persistent Hypoglycemia: Evaluation and Management

Author: Nicole Anthony, MD Peer Reviewer: Trevor Cerbini, MD In Part 1 of our 2-part series on hypoglycemia, Erroneous Blood Glucose Readings and Where To Find Them, we introduced the vignette of a patient in Read more…

%d bloggers like this: