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Self-Assessment Questions

Orthopaedic Surgery

Disorders of the Hip: Review Questions

Brett R. Levine, MD

Dr. Levine is an attending physician, Midwest Orthopaedic Center, Peoria, IL.


Choose the single best answer for each question.


Figure 1

Questions 1 and 2 refer to the following case.

A 12-year-old obese boy presents with a 4-week history of right knee and groin pain. During this time, his parents report that he has developed a worsening limp and low-grade fevers. On physical examination, the patient has limited flexion, abduction, and internal rotation of the right hip because of the pain. Gentle log roll test of the leg is well tolerated. The patient is able to bear weight but ambulates with a significant antalgic gait. A frog-leg lateral radiograph of the patient’s right hip is shown in Figure 1.


1. What is this patient’s most likely diagnosis?

  1. Developmental hip dysplasia
  2. Femoral neck fracture
  3. Juvenile rheumatoid arthritis
  4. Septic arthritis
  5. Slipped capital femoral epiphysis (SCFE)
Click here to compare your answer.


2. Which of the following is the most appropriate treatment for this patient?

  1. Closed reduction and spica casting
  2. In situ screw fixation
  3. Irrigation and dŽbridement with intravenous antibiotics
  4. Open reduction and internal fixation
  5. Total hip arthroplasty
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3. A 24-year-old man presents with a 5-day history of acute-onset left hip pain. A detailed history reveals blurred vision and clear discharge from his right eye as well as pain with urinating over the same duration. His past medical history reveals cervical spine and sacral pain and keratoderma blennorrhagicum. On prior testing, he was also HLA-B27 positive. What is this patient’s most likely diagnosis?

  1. Ankylosing spondylitis
  2. Paget’s disease
  3. Psoriatic arthritis
  4. Reiter syndrome
  5. Rheumatoid arthritis
Click here to compare your answer.


Questions 4 and 5 refer to the following case.

A 47-year-old man with a past history of alcohol abuse presents with a 2-day history of acute-onset, right-sided hip pain that started while he was working in his yard. The patient also has a 2-month history of intermittent hip pain. On physical examination, he is afebrile and has significant limitations in rotation of his hip (ie, internal rotation to neutral and external rotation of 20°). He has a 20-degree flexion contracture and ambulates with an antalgic gait. Laboratory tests reveal a normal C-reactive protein level and white blood cell count, but his erythrocyte sedimentation rate is slightly elevated at 21 mm/hr. An anteroposterior (AP) radiograph of the right hip is shown in Figure 2.


4. What is this patient’s most likely diagnosis?

  1. Acute femoral neck fracture
  2. Ankylosing spondylitis
  3. Legg-Calve-Perthes disease
  4. Osteonecrosis of the femoral head
  5. Septic arthritis
Click here to compare your answer.



Figure 2

5. After further discussion, the patient reveals that he has had some vague left-sided hip pain over the last month. Standard AP and lateral radiographs of the left hip appear normal. What imaging modality is most appropriate for confirming and classifying this patient’s diagnosis?

  1. Computed tomography (CT) scan
  2. Indium bone scan
  3. Inlet and outlet radiographs
  4. Magnetic resonance imaging (MRI)
  5. Technetium bone scan
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Questions 6 and 7 refer to the following case.

A 32-year-old man presents to the emergency department with a 1-month history of right groin pain. Over the past 72 hours, he has been unable to bear weight on his right lower extremity. He is currently training for a marathon and has been running a minimum of 50 miles a week for the past 6 months. On physical examination, his temperature is 99°F (37.2°C). There are no obvious deformities to his right lower extremity. Range of motion of the hip is limited because of the pain: flexion, 90 degrees; abduction, 30 degrees; internal rotation, 5 degrees; and external rotation, 20 degrees. Plain radiographs of the right hip appear normal. MRI shows a low-intensity signal of the superior-lateral aspect of the femoral neck on the T1-weighted images.


6. A 63-year-old man lands awkwardly while skiing and hears a loud pop in his left ankle. He cannot bear weight on the ankle, and edema ensues soon after the injury. Which of the following fractures would be missed if only radiographs of the ankle are taken without knee examination or radiographs of the entire lower leg?

  1. Calcaneal fracture
  2. Maisonneuve fracture
  3. Pilon fracture
  4. Pott fracture
  5. Talar neck fracture
Click here to compare your answer.


7. A 63-year-old man lands awkwardly while skiing and hears a loud pop in his left ankle. He cannot bear weight on the ankle, and edema ensues soon after the injury. Which of the following fractures would be missed if only radiographs of the ankle are taken without knee examination or radiographs of the entire lower leg?

  1. Calcaneal fracture
  2. Maisonneuve fracture
  3. Pilon fracture
  4. Pott fracture
  5. Talar neck fracture
Click here to compare your answer.
 

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