Knee Pain



Knee Pain
An 11-year-old boy presents with acute onset left knee pain.  The boy states that he was running the bases during a baseball game, when he felt a “pop”, and fell on his left knee.  He has no past medical history.  On exam, he has normal vital signs.  His head-to-toe exam is normal, except for a swollen and painful left knee; he is neurovascularly intact distally.

His left knee plain radiographs are below:

Regarding his presentation and management, which of the following is the BEST answer:

    A.    This is a common presentation in his age range; once reduced, his fracture will heal readily
    B.    This is a significant comminuted fracture as demonstrated by the lateral film; he will require an intramedullary rod
    C.    He will require both medical and surgical intensive treatment
    D.    He should be evaluated for a deep bone infection



Dr. M
10/01/2012 8:03am

Gonna have to guess on this one. I think the answer is C. I am concerned that this is a pathologic fracture through some oncologic bone process given the abnormal bony formation visualized on the lateral x-ray with the positive arrow sign.

10/01/2012 10:57am

C. osteosarc. One of top pediatric bony cancers and common in distal femur/ proximal tib

10/01/2012 12:05pm

C. Agree with DCAL - "until proven otherwise"


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