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

AAOS Now

Published 10/1/2012

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.

Fig. 1 Anteroposterior radiograph of a 4-year-old boy who limped and complained of hip pain.
Fig 2. MRI showing stress fracture

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

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.

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