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PRESENTATION
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POLLS
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OUTCOMES
20
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VIDEOS
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EVIDENCE
63
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Comments
50
CASE DESCRIPTION
AGE 14 / Male
CC Right hip pain
HPI A 14-year-old male presents with 1 month of worsening right hip pain. He denies any trauma. The pain has been worsening to the point where he started using crutches 1 week ago. He is still able to bear some weight with crutches but is not mobilizing well.
PMH Past medical history is negative for any metabolic or endocrine disorders.
PE Gen: He is in no acute distress. BMI of 26.6 kg/m^2 Focused physical examination of the right lower extremity demonstrates TTP diffusely about the right hip. Severe pain noted with attempted logrolling of right hip. There are no overlying skin changes. He is neurovascularly intact distally. Focused physical examination of the left lower extremity does not elicit any tenderness or pain with logroll. He flexes the hip >100º, with IR of 20º and ER of 45º. No obligate external rotation is noted with hip flexion. He is neurovascularly intact distally.
Pre-procedure IMAGES:
https://devupload.orthobullets.com/cases/101997/1e6a34fb-cd22-42cd-aca0-684edddd7c69_preop_ap_pelvis.jpg https://devupload.orthobullets.com/cases/101997/2c7ea0ed-1761-42f5-a122-736e5484acf1_preop_frog_leg_lat.jpg
POLLS
OB Community
1) In addition to the plain film pelvic radiographs shown, would you obtain other imaging to guide management?
Other
2) Would you use a classification system to guide your management?
Other
3) How would you manage the patient at this time?
Other
4) If you choose Operative management, and this patient presented at 3pm, when would you perform surgery?
Other
5) If you choose Operative management, what surgery would you perform for the right hip?
Other
6) If you choose Operative management of the epiphyseal/metaphyseal slip with a Modified Dunn procedure, what construct would you prefer?
Other
7) If you choose Operative management, would you perform prophylactic fixation of the contralateral (LEFT) hip?
Other
8) If you choose Operative management of the right hip and obtained the construct below, how would you manage weight bearing post-operatively?
Other
9) Given the radiographic findings of the left hip 6 months after right hip ORIF and new onset of left hip pain, how would you manage the patient at this time?
Other
10) If you choose Operative management of the LEFT hip at this time, what surgery would you perform?
Other
CASE OUTCOMES
PROCEDURE 1: Right Surgical Hip Dislocation and Modified Dunn Procedure
Intra-procedure P1
https://devupload.orthobullets.com/cases/101997/f9864818-6d82-4266-945c-2a8579680e2b_fluoro_epi_pinning_1.jpg https://devupload.orthobullets.com/cases/101997/c2c752d3-9c99-4bf4-953b-b28aef2edc74_fluoro_neck_reduction_2.jpg https://devupload.orthobullets.com/cases/101997/5c5d0a81-7e7d-463a-8267-ed002a7d00e6_fluoro_troch_fixation_3.jpg https://devupload.orthobullets.com/cases/101997/c9ac88e2-9435-4080-94c4-8a90d1f95543_fluoro_ap_troch_fixation_with_pins_4.jpg https://devupload.orthobullets.com/cases/101997/d06805ca-67dd-4a59-bd5c-8632042b5174_fluoro_lat_troch_fixation_pins_5.jpg https://devupload.orthobullets.com/cases/101997/a098599a-941c-49a0-adab-d3877b45dbb7_fluoro_ap_screw_fixation_6.jpg https://devupload.orthobullets.com/cases/101997/d466529a-4298-444f-9969-c8bcddf9f503_fluoro_lat_screw_fixation_7.jpg https://devupload.orthobullets.com/cases/101997/2647a23d-cbc5-4172-bcdd-fd5da4cc96ac_fluoro_screw_fixation_lat_diff_view_8.jpg https://devupload.orthobullets.com/cases/101997/0aca830f-796f-4a24-b60a-4aa430d65d4d_fluoro_screw_fixation_ap__final_9.jpg
Post-procedure P1
https://devupload.orthobullets.com/cases/101997/1c2261ab-e9c6-49c2-9f4c-a4fa1acb48cc_immediate_post_op_first_md_ap.jpg https://devupload.orthobullets.com/cases/101997/ab9fee38-449e-4055-a12c-2e56d268a5e8_immediate_post_op_md_lat.jpg https://devupload.orthobullets.com/cases/101997/22d63d9a-7a93-40fe-8a53-3035ecf0675e_3_mo_followup_md_ap.jpg https://devupload.orthobullets.com/cases/101997/8df4a564-7be3-4b4d-bb76-0b43c9f20e86_3_mo_fu_md_lat.jpg https://devupload.orthobullets.com/cases/101997/f4a8c5ca-3b42-4cde-a325-d884df97f4f7_ap_6_mo_left_slip.jpg https://devupload.orthobullets.com/cases/101997/7b8d7408-ceb0-41eb-8c0c-3aba42eeb721_frog_6_mo_left_slip.jpg
PROCEDURE 2: Left Hip Percutaneous Screw Fixation
Intra-procedure P2
https://devupload.orthobullets.com/cases/101997/b17bfa4d-2c3f-499d-8286-b125ccbe3175_fluoro_left_ap_pining.jpg https://devupload.orthobullets.com/cases/101997/8ddf3398-0646-4339-9f88-137f02a235bb_fluoro_left_ap_screw.jpg https://devupload.orthobullets.com/cases/101997/e3d139da-895f-4326-9861-df2b1033182a_fluoro_left_lat_screw.jpg
Post-procedure P2
https://devupload.orthobullets.com/cases/101997/3bf63caa-8ad1-4b28-8b44-f87eaf5853e4_final_follow_up_ap_pelvis.jpg https://devupload.orthobullets.com/cases/101997/a837f401-6f7c-4db7-b143-1edbcee3a8a0_final_follow_up_frog_lat_pelvis.jpg
VIDEOS & PODCASTS (3)
EVIDENCE (63)
EXPERT COMMENTS