ROSH REVIEW Orthopedics Questions And Answers | Latest Study Solutions

A 12-year-old baseball player presents with knee pain. It occurs mainly during running the bases. Tenderness and edema are prominent about the right tibial tuberosity, and resisted knee extension is painful. The remainder of the knee examination is normal. Radiographic examination of this patient would most likely reveal which of the following abnormalities? Bipartite patella Heterotopic ossification Increased density of the femoral condyles Pars interarticularis defect - Correct Answer ( B ) Explanation: Tibial tuberosity osteochondritis is called Osgood-Schlatter disease (OSD). Repetitive quadricep contraction can lead to avulsions at the secondary ossification center between the tibial tuberosity and the patellar tendon. Incidence is greatest in adolescent boys who are active in sports. Symptoms include anterior proximal tibial pain, which is worse with running, jumping and prolonged sitting. Examination typically reveals unilateral tibial tuberosity tenderness and edema with restricted and tender kneeling. Lateral radiographs typically show spicules of heterotopic ossification anterior to the tibial tuberosity. Intermittent ice, NSAIDs and rest are common treatment options. Immobilization may be required for recalcitrant cases. Surgery is commonly unnecessary, and prognosis is typically good. Bipartite patella (A) may present with superolateral patellar pain, but not commonly with tibial tuberosity pain. Increased density of the femoral condyles (C) is not present in OSD. Increased density of the femoral head is common in Legg-Calve-Perthes disease, the childhood disorder of hip avascular osteonecrosis. A defect in the pars interarticularis (D), the bony junction of the superior and inferior articular processes of the vertebral posterior columns, can lead to spondylolisthesis and back pain, not knee pain. A 12-year-old boy is brought to his pediatrician's office for right knee pain that started three months ago after starting basketball practices. On physical exam, the boy is tender to palpation over the anterior tibial tubercle. There is no erythema or warmth to the area. A lateral radiograph of the knee reveals elevation of the tibial tubercle away from the shaft. Based on the likely diagnosis, which of the following is the most appropriate management?Acetaminophen and continued activity as tolerated Activity avoidance until pain resolution Knee immobilization and crutches Referral to orthopedics for glucocorticoid injection - Correct Answer ( A ) Explanation: Osgood-Schlatter disease is best managed with acetaminophen and continued activity as tolerated. Osgood-Schlatter disease is a traction apophysitis of the proximal tibial tubercle at the point of patellar tendon insertion. Osgood-Schlatter disease is caused by repetitive quadriceps contraction, which results in excessive patellar tendon traction on the skeletally immature tibial tendon. Osgood-Schlatter disease is most commonly seen in 9-14 year old children who have undergone a rapid growth spurt. It is more common in children and adolescents who are participant in sports. Osgood-Schlatter disease is more common in athletes who participate in sports that involve running, cutting, and jumping. Anterior knee pain that gradually worsens over time is the most common presenting complaint. Physical exam findings typically include tenderness and soft tissue or bony prominence of the tibial tubercle. The pain can be exacerbated by having the patient extend the affected knee against resistance or squatting with the knee in full flexion. Erythema and warmth are not typical findings and warrant further evaluation for more serious conditions, such as osteomyelitis or malignancy. Radiographs are not necessary in patients with clinical findings characteristic of Osgood-Schlatter disease, but may be used to exclude other conditions. Radiographic findings findings may include anterior soft tissue swelling or tibial tubercle abnormalities. Because Osgood-Schlatter disease is usually benign and self-limited, conservative measures are the mainstay of treatment. Conservative treatment includes pain control, continuation of activity, and physical therapy. Non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and ice may help control the pain. Patients should continue to participate in activity as A 12-year-old obese boy presents with groin and proximal anterior thigh pain. He has no pain below the knee. Physical examination shows a significant decrease in internal rotation of the affected hip. Radiographs show a widened growth plate. Which of the following is the most likely diagnosis? Acute transient synovitis Legg-Calve-Perthes disease Osgood-Schlatter disease Slipped Capital Femoral Epiphysis - Correct Answer ( D ) Explanation: Atraumatic pediatric hip pain or limp is usually caused by acute transient synovitis, Legg-Calve-Perthes disease (LCP) or Slipped Capital Femoral Epiphysis (SCFE). SCFE is a fracture in the physis (growth plate) of the femoral head which leads to slippage of the overlying epiphysis. It usually occurs duringadolescent growth spurts. Predisposing factors include male sex, obesity and increased sports activities. The typical age range is 10-14 years for girls and 11-16 years for boys. Patients present with pain in the anterior proximal knee or thigh that is exacerbated by activity. On exam, there is loss of hip internal rotation, particularly with the hip flexed. Patients typically walk with the involved extremity externally rotated. AP and frog-leg radiographs show "ice cream falling off the cone." All cases warrant urgent orthopedic evaluation for stabilization surgery. Patients should be nonweight bearing and restricted to bed rest until then. Complications of untreated disease include chondrolysis and osteonecrosis. A 13-year-old obese boy presents with complaints of right anterior thigh pain and a limp for 2 weeks. There is no history of trauma. On exam, he is able to bear weight but walks with his right foot externally rotated. He has decreased motion of his right hip and when his hip is flexed, the extremity externally rotates. The patient is afebrile. White blood cell count is 8,000. Which of the following is the most likely diagnosis? Developmental dysplasia of the hip Legg-Calve-Perthes disease Septic arthritis of the hip Slipped capital femoral epiphysis - Correct Answer ( D )