Ch. 28 Right Groin Pain and Limp

Question 1

What is the mgmt of the following:

1. Septic arthritis
2. Lyme disease
3. Psoas abscess

Answer 1

What is the mgmt of the following:

1. Septic arthritis: Joint aspiration and blood cultures which dictate abx selection; emergent incision and drainage
2. Lyme disease: Doxycycline, amox
3. Psoas abscess: Abx +/- I&D

Question 2

What is the mgmt of the following:

1. Juvenile idiopathic arthritis
2. Transient synovitis

Answer 2

What is the mgmt of the following:

1. Juvenile idiopathic arthritis: DMARDs, NSAIDs, frequent ophthalmologic exams; watch for C1-2 instability and myelopathy
2. Transient synovitis: Observation and NSAIDs; r/o septic arthritis

Question 3

What is the mgmt of the following:

1. Developmental dysplasia of the hip
2. Legg-Calve-Perthes disease
3. Stress fracture
4. Slipped capital femoral epiphysis

Answer 3

What is the mgmt of the following:

1. Developmental dysplasia of the hip: 0-6 mo: Pavlik Harness
2. Legg-Calve-Perthes disease: Most pts do not require tx (symptomatic and supportive) +/- casting
3. Stress fracture: Period of non- or protected weight bearing +/- casting/bracing
4. Slipped capital femoral epiphysis: In situ screw fixation across capital physis

Question 4

What is the mgmt of the following:

1. Neoplastic
   
   1. Benign
      
      1. Osteoid osteoma
      2. Other benign bone lesions
   2. Malignant
      
      1. ​Osteosarcoma
      2. Ewing’s sarcoma

Answer 4

What is the mgmt of the following:

1. Neoplastic
   
   1. Benign
      
      1. Osteoid osteoma: Percutaneous radiofrequency ablation (RFA) if symptoms not controlled with NSAIDs
      2. Other benign bone lesions: Observation vs. intralesional curettage and grafting
   2. Malignant
      
      1. ​Osteosarcoma: Neoadjuvant chemo + wide surgical resection
      2. Ewing’s sarcoma: Neoadjuvant chemo + wide surgical resection

Question 5

SCFE: typical presentation?

Mgmt?

Answer 5

Obese, adolescent male aged 10-16 y/o presenting with groin pain, painful limp, externally rotated hip, not irritable (e.g., patient allows ROM)

Knee pain is referred from hip pathology in young children until proven otherwise

Mgmt? Admission to hospital for urgent in situ surgical pinning of the hip with a single screw