2025 – PAGE 416 – ORTHOPEDICS AND SPORTS MEDICINE
LEGG-CALVE-PERTHES DISEASE
Legg-Calve-Perthes disease is also known as IDIOPATHIC AVASCULAR NECROSIS of the femoral head, or OSTEOCHONDROSIS of the femoral head. As the names suggest, a lack of blood flow causes necrosis to the femoral head for unknown reasons. It occurs in children younger than 8 years of age. Diagnose by looking for an irregularly shaped femoral head on the X-ray. Treat with casting or bracing, and let the parents know that the blood supply will go back to normal with time.
PEARLS: This often presents with a PAINLESS LIMP but can be associated with referred HIP PAIN, and knee pain (less frequent). Also, when comparing X-rays to Slipped Capital Femoral Epiphysis, you will note that the femoral head shape is extremely irregular and jagged.
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OSGOOD SCHLATTER DISEASE
Osgood Schlatter disease usually presents in active children around the time of adolescence, or a growth spurt, with pain below the knee. It occurs due to traction at the tibial tubercle by the patellar tendon at the point of insertion. Treatment is dependent on the severity, with the most severe cases requiring rest from the sport for a few weeks. Other treatment modalities include NSAIDS to reduce swelling and pain, a patellar tendon strap to help with pain, a knee pad to help protect the area from direct trauma and stretching of the hamstrings and quadriceps muscles. A mild prominence may be noted into adulthood.
PEARL: This is typically a UNILATERAL problem, though it can occur on the other side later. Diagnosis can be clinical. If asked what imaging study to get, obtain a lateral X-ray.
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OSTEOCHONDRITIS DISSECANS
In osteochondritis dissecans, children complain of a knee that locks up. Look for swelling on exam. It’s caused by necrosis of the articular surface of a joint, usually the KNEE, and can lead to chronic pain. Treat with immobilization. If it doesn’t get better, it may require surgical removal of bone fragments.
SCOLIOSIS
Scoliosis usually occurs around the time of a growth spurt. Children will have findings that include asymmetric hips or scapulae. If shown a picture, look for one shoulder to be higher than the other. When severe, it can present with neurologic symptoms, such as paresthesias or weakness of the lower extremities.
PEARL: Know this! Regarding treatment, if the curvature is < 25 degrees, observation is okay. If the curvature is > 25 degrees, brace the child if s/he is still growing. If the curvature is > 40 degrees, they will need to get surgery.
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SPONDYLOLYSIS
Spondylolysis is a true fracture of the vertebral pars. It can present with pain that is noted with standing, extension at the hip, or the straight leg raise test. It can occur with vigorous physical activity.
PEARLS: The straight leg raise is positive when the patient is supine and they have pain as you passively raise their leg at 10–60 degrees. It indicates a radiculopathy. Note that this condition has pain with standing, while common BACK STRAINS are associated with relief of pain with standing.
PEARL: Look out for a gymnast with back pain!
MNEMONIC: LYSIS = BREAK! Always break down the words!
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