Question

Obese 12 yo male presents with a 1 month history of right thigh pain worsened with weight bearing. Exam is normal, however radiographs reveal a posterior and medial displacement of the femoral head. Most likely dx

Answer 1

The symptoms and radiographic findings suggest the most likely diagnosis is Slipped Capital Femoral Epiphysis (SCFE), a condition where the femoral head displaces postero-medially. Radiographs of the femur are used to estimate a child's age by assessing the presence or absence of epiphyseal plates.

Step-by-step explanation:

The student's description of symptoms and radiographic findings in an obese 12-year-old male with right thigh pain suggests the most likely diagnosis is Slipped Capital Femoral Epiphysis (SCFE). In SCFE, the femoral head displaces posteriorly and medially relative to the femoral neck, which is consistent with the radiographic evidence provided.

This condition is commonly seen in overweight children during their growth spurts. SCFE is a serious condition that requires orthopedic evaluation and often surgical intervention to prevent further slippage and potential complications such as avascular necrosis or early arthritis.

As for the question on how a radiograph of a child's femur can be used to determine the approximate age of that child: The presence or absence of epiphyseal plates (growth plates) can indicate the stage of bone development and thus provide an approximate age. The lesser trochanter epiphyseal plate appears around age 9-10 and disappears at puberty, indicating an approximate age of 10 years if present on radiograph.