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Discussion Starter · #1 ·
The mother of a 5 year old boy noticed a limp for a few days.

Here is his hip x ray shown below. What is the most appropriate treatment?

A) Chemotherapy
B) Urgent admission and antibiotics
C) Observe and limited weight bearing
D) Surgery
E) Closed reduction

Medical imaging Jaw Organism Radiography Medical
click image to enlarge
 

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I would say C.

Legg-Calve-Perthes disease
-MC in boys between 4 and 10
-idiopathic infarction of femoral capital epiphysis (head)
-the vascular anatomy of the proximal femur is in a transitional stage at age 4-7
-present with hip, groin, or knee pain plus an antalgic gait
tx: manage conservatively with observation and bracing, though surgery may be indicated if femoral head is not contained within the acetabulum

For a much more thorough and helpful explanation of pediatric hip disorders, check out http://www.falconreviews.com/v3/blog/2010/11/pediatric-hip-disorders/
 

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Discussion Starter · #3 ·
Thanks healer2b. The link is useful.

Three main conditions repeatedly show up on the USMLE: congenital hip dysplasia, Legg-Calve-Perthes disease, and slipped capital femoral epiphysis.
 
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