Femoral Epiphyseal Fragmentation
Approach to Child with Femoral Epiphyseal Fragmentation
This is from Yaser’s case that Chris presented him.
Child with painless limp, right side.
– go through the differential diagnosis of painless limp: congenital, developmental, inflammatory, neoplastic, vascular, bony dysplasia, infectious: most of these have pain. Perthes is the classic painless limp. Also SCFE.
Go through the history, looking for systemic signs, trauma, previous infections, other joints involved, other dysmorphic features, height/weight (bony dysplasias),
On physical, look for gait abnormalities (lurch), abductor weakness, leg length, signs of spinal dysraphism, endocrine abnormalities, wasting, neurology, limitations of motion. Perthes often have decreased internal rotation and abduction. DDH has limited abduction. SCFE have obligatory external rotation with flexion.
Now, for the x-rays: unilateral or bilateral sclerosis and fragmentation of the femoral epiphysis
– first thing, make sure you look at both hips!
– don’t jump to the conclusion that the kid has Perthes
The other possibilities include:
– Meyer’s dysplasia (if really young