Lower Extremity Injuries in Children Jonathan Pirie, MD, MEd, FRCPC, FAAP (PEM) KEC 2015-05 10 y.o. male with thigh pain, limp Case • 10 year old male • 3 week history of right thigh and knee pain • Seen by family M.D. - X-rays - N • No history of trauma • Missing school • Physical exam Wt. 82.5 kg • limp • decrease internal rotation, flexion of hip Abnormal Klein’s Line Normal Slipped Femoral Capital Epiphysis • Typically male adolescent, overweight • Clinical – acute or chronic, hip, groin, anterior thigh or knee pain – P/E - limitation of internal rotation, flexion and abduction of hip • X-ray – may not be apparent on AP – frog-leg view • Rx: Immediate Ortho referral
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Case Abnormal Klein’s Line - Kindercare Pediatrics · Lower Extremity Injuries in Children Jonathan Pirie, MD, MEd, FRCPC, FAAP (PEM) KEC 2015-05 10 y.o. male with thigh pain, limp
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Lower ExtremityInjuries in Children
Jonathan Pirie, MD, MEd, FRCPC, FAAP (PEM)
KEC 2015-05
10 y.o. male with thigh pain, limp
Case • 10 year old male
• 3 week history of right thigh and knee pain
• Seen by family M.D. - X-rays - N
• No history of trauma
• Missing school
• Physical exam Wt. 82.5 kg
• limp
• decrease internal rotation, flexion of hip
Abnormal Klein’s LineNormal
Slipped Femoral Capital Epiphysis
• Typically male adolescent, overweight • Clinical
– acute or chronic, hip, groin, anterior thigh or knee pain
– P/E - limitation of internal rotation, flexion and abduction of hip
• X-ray – may not be apparent on AP – frog-leg view
• Rx: Immediate Ortho referral
5 yo with a limp x 3 weeks Legg Calve Perthe’s Disease
• The etiology: vascular insufficiency • Ages 4 and 8
– with a distinct male predominance.
• Bilateral in about 10% of cases, – with the hips involved sequentially, not
simultaneously.
• Management: outpatient referral to Ortho
Adolescent printer stops suddenly Pain in R Hip
Avulsion # ASIS Avulsion # AIIS
Avulsion # Ischial Tuberosity in a JumperHip-Pelvis Avulsion Fractures
• Most common in adolescents
• Mechanism: sudden, forceful, concentric or eccentric contraction of a large muscle in an attempt to accelerate or decelerate