Ortho case week 1
July 17, 2019

A 12-years-old male patient not known to have any medical illness previously brought to the clinic with his parent with recent new onset of limping and right knee pain, no history of trauma, no history of involvement in aggressive sports. The knee pain started two weeks back more at the medial side of the knee no related to movement of the joint, constant pain and not improved by resting.

No previous medical illness, no surgical history.

On examination:

Antalgic gait

foot progressing angle: Mild external rotation right foot

Hip: mild groin tendernss and lateral hip

ROM: mild limitation in internal rotation, normal flexion and extension, no spastisty

Knee: diffuse medial side tenderness, no signs of infection, normal ROM

Ankle and subtalar joint: normal

Foot: normal foot thigh angle, no MTA

Spine: normal, no midline deformity, no abnormal hairy patches or lesions

Distal neurovascular intact

 

X-ray:

 

 

 

Reference: Paediatric Knee Radiographs: Normal Appearances of the Knee Joint in the Growing Patient

 

Hip x-ray:

Reference: Early diagnosis of slipped capital femoral epiphysis on magnetic resonance imaging: A case report with review of literature

What findings can be seen on diagnostic imaging? What are the next best steps in management?