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A 13-year-old overweight patient presents to the emergency department with left knee pain and is lying in bed with his hip slightly flexed. He is found on imaging to have a severe slipped capital femoral epiphysis. If his leg is not manipulated for imaging, in what abnormal position is his left hip most likely to appear on an anteroposterior pelvic radiograph?
Select Answer to see Preferred Response
A 12-year-old male previously presented with 4 days of left groin pain and inability to bear weight. Radiographs taken preoperatively, 1 week and 8 months postoperatively are seen in Figures A through C. What complication has occurred?
Secondary loss of fixation
A 12-year-old mildly overweight female presents with complaints of left hip pain. She is not dependent on crutches for ambulation. Physical examination reveals external rotation of the extremity with hip flexion. Her parents indicate that outside radiographs were interpreted to be normal. They present an MRI of the pelvis, as shown in Figures A and B. What is next best step in management?
Arthroscopic labral repair
In situ screw fixation
Closed reduction and percutaneous pinning
Debridement of CAM impingement femoral lesion
A 13-year-old male presents with left hip pain and an inability to ambulate. He does not have a history of kidney disease. The initial radiograph is shown in Figure A. Which of the following zones of the growth plate (Figures B-F, all the same magnification) is most commonly involved in this condition?
A 12-year-old girl presents with groin pain six months after treatment of a slipped capital femoral epiphysis. Preoperative radiographs are seen in Figure A, radiographs six months after in situ fixation are seen in Figure B. Which of the following is associated with the radiographic abnormality seen in Figure B?
Lack of reduction prior to fixation
Single screw fixation
Inability to bear weight preoperatively
An 11-year-old obese male presents with a slipped capital femoral epiphysis. Which of the following figures accurately represents the method used to determine the radiographic severity of the epiphyseal slip and help guide treatment?
A 13-year-old boy complains of a 3-month history of left knee, thigh and groin pain. His pain has significantly worsened over the past week. He denies pain in the right leg. Radiographs are taken and shown in Figures A and B. The history and physical do not reveal any findings concerning for an endocrine disorder. What is the preferred method of treatment?
Subtrochanteric valgus, extension, and external rotational osteotomy
Non weight bearing on the left side for 6 weeks.
Bilateral in situ single screw insertion across the proximal femoral physis
In situ single screw insertion across the left proximal femoral physis only
Varus derotational osteotomy of the proximal femur
A 10-year-old female with right hip pain presents with the radiographs in Figure A. She has a past medical history of hypothyroidism. She undergoes in-situ screw fixation of her right hip with no intra-operative complications. Which of the following problems is most likely to occur in this scenario?
Ipsilateral knee pain
SCFE on contralateral hip
Figures 39a and 39b show the current radiographs of an 8-year-old girl who has had pain in the left thigh for the past 3 months. She was recently diagnosed with hypothyroidism and started treatment 1 week ago. Examination reveals a mild abductor deficiency limp on the left side. She lacks 30 degrees internal rotation on the left hip compared with the right hip. Management should consist of
abductor muscle strengthening.
a left 1-½ hip spica cast.
closed reduction and pinning of the left hip.
symptomatic treatment with crutch walking and nonsteroidal anti-inflammatory drugs.
in situ pinning of both hips.
The rate of complications after in situ pinning of a chronic slipped capital femoral epiphysis is highest with placement of the screw in what quadrant of the femoral head?
A 12-year-old boy reports limping and chronic knee pain that is now inhibiting his ability to participate in sports. Clinical examination and radiographs of the knee are normal. Additional evaluation should include
mechanical alignment radiographs.
stress radiographs of the knee.
comparison radiographs of both knees.
an erythrocyte sedimentation rate and a C-reactive protein.
examination of the hip.
Of the following clinical situations, which is most likely to lead to osteonecrosis associated with a slipped capital femoral epiphysis (SCFE)?
A girl younger than age 15 years
A boy younger than age 15 years
An unstable SCFE
A stable SCFE
A stable SCFE associated with morbid obesity
Which of the following treatment techniques decreases the risk of osteonecrosis in patients with unstable slipped femoral capital epiphysis (SCFE)?
Open reduction and pinning with multiple cannulated screws in an inverted triangle configuration
Closed reduction and pinning with multiple cannulated screws in an inverted triangle configuration
Closed reduction and pinning with a single cannulated screw
In situ percutaneous pinning with multiple cannulated screws in an inverted triangle configuration
In situ percutaneous pinning with a single cannulated screw
Southwick angle (epiphyseal-shaft angle) serves what purpose in the evaluation of a slipped capital femoral epiphysis (SCFE)?
Determine prognosis for AVN
Determine the severity of the slip
Determine the presence or absence of a slip
Determine the etiology of a slip
Determine the chronicity of the slip
Hypothyroidism is most commonly associated with which of the following pediatric conditions?
Legg Calve Perthes
Slipped capital femoral epiphysis
An 11-year-old girl with hypothyroidism and obesity presents with groin pain and the inability to ambulate. Her radiograph is shown in Figure A. What is the most appropriate treatment?
Toe-touch weightbearing for 3 weeks
Hip spica cast and non-weight bearing for 4 weeks
In situ pinning of the right hip
Open reduction and pinning of the right hip
In situ pinning of both hips
A 13-year-old Polynesian boy presents with left groin pain and inability to place weight on the left leg. His radiographs are shown in Figures A and B. All of the following are true regarding this condition EXCEPT:
The left hip is more commonly involved
Forceful manipulation is not indicated because it is associated with an increased risk of complications
Associated with decreased femoral anteversion and decreased femoral neck-shaft angle
Pain is localized to the knee more often than the hip on initial presentation
Males are more commonly affected than females
A 14-year-old boy presents with left groin and knee pain for 3 weeks. He is now unable to place weight on the left lower extremity, even with the assistance of crutches. AP pelvis radiograph is shown in Figure A. He is treated with surgical intervention and post-operative radiographs are shown in Figures B and C. What is the most common limb length and rotational profile found as a sequelae of this condition?
Limb shortening, decreased hip flexion and decreased hip internal rotation
Limb lengthening, increased hip flexion, and increased hip internal rotation
Limb lengthening, decreased hip flexion, and decreased hip external rotation
Limb shortening, decreased hip flexion, and increased hip internal rotation
Limb shortening, increased hip flexion, and decreased hip internal rotation
A 14-year-old female presents with a history of an undiagnosed left slipped capital femoral epiphysis 3 years ago. She has 2 years of activity-related left hip pain and pain with prolonged sitting. On physical examination she has restricted hip flexion motion, an external rotation deformity, and obligatory external rotation upon hip flexion manuevering. Radiographs are shown in Figures A and B. Which of the following osteotomies is MOST appropriate?
Medial displacement Chiari salvage osteotomy
Proximal femoral varus osteotomy
Flexion, internal rotation, and valgus-producing proximal femoral osteotomy (Imhauser osteotomy)
Bernese periacetabular osteotomy with extension, external rotation, and valgus-producing femoral osteotomy
Valgus-producing intertrochanteric proximal femoral osteotomy (Pauwel osteotomy)
A right hip of an 8-year-old patient is modeled in Figure A. Which of the following vessels gives the greatest blood supply to the femoral head?
A 14-year-old overweight boy complains of vague left knee pain which worsens with activity. He has an antalgic gait and increased external rotation of his foot progression angle compared to the contralateral side. Knee radiographs, including stress views, are negative. What is the next step in management?
AP pelvis and frog-lateral views
Diagnostic knee arthroscopy