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What’s Your Diagnosis

In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted.

The images for this month’s challenge were submitted by Michael Amini, MD, a resident member at the University of Tennessee-Campbell Clinic. Dr. Amini also provided the following information:

The patient is a 4-year-old boy who came to the clinic with a mild limp and Trendelenburg gait on the left. He has had no fever, chills, or other constitutional symptoms. The parents deny any trauma, and radiographs (Fig. 1) were inconclusive. A 2-week course of conservative treatment (NSAIDs) was ineffective, and the boy continued to limp and complain of pain in his hip.

What’s your diagnosis? Is it transient viral synovitis? Septic arthritis? A stress fracture? Early onset Legg-Calvé-Perthes?

Fig. 1 Anteroposterior radiograph of a 4-year-old boy who limped and complained of hip pain.

Find the answer to this month’s challenge below

Answer
According to Michael Amini, MD, who submitted the case, the diagnosis is a stress fracture of the inferior aspect of the femoral neck, which was evident on the MRI (Fig. 2). Dr. Amini reports that this was the youngest reported case of such a fracture. The child was treated with crutches and an abduction brace with a pelvic band, and the stress fracture healed and symptoms were resolved in 3 months.

Fig 2. MRI showing stress fracture

Send AAOS Now your case
Do you have a challenging case you’d like to submit for publication? Email a short case description and any accompanying images to aaoscomm@aaos.org

AAOS Now
October 2012 Issue
http://www.aaos.org/news/aaosnow/oct12/clinical3.asp

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