Best Practice Case Studies-Study Questions (A VIOLINIST AND HER ELBOW)

Pdf Summary

In CASE 43, an 11-year-old girl presents with anterior knee pain during jumping activities. X-rays reveal a lucency in the patella, and an MRI confirms intact articular cartilage over a bony loose body. The growth plates are still open, indicating that she is still growing. She is diagnosed with osteochondritis dissecans, a condition where a segment of bone and its adjacent cartilage lose blood flow and may become detached and eventually fragment.<br /><br />The recommended management for her condition is option A: activity modification and close follow-up. Since she has open growth plates and a stable lesion with intact cartilage, non-surgical management is the first line of treatment. This approach involves reducing activities that place stress on the knee, such as running and jumping, followed by regular monitoring to assess healing progress. If the condition does not improve with conservative management over at least six months, surgical options may then be considered.<br /><br />Surgical drilling or physical therapy (options B and D) are not recommended at this stage because there is no articular cartilage instability or evidence that physical therapy improves outcomes in this scenario. Continuing her normal activities without modification (option C) is also not advised due to the presence of symptoms, which necessitates activity modification to prevent further injury or deterioration.<br /><br />References for the management decision include publications in the "Orthopedic Clinics of North America" and guidelines from the American Academy of Orthopaedic Surgeons, which underscore the priority of conservative management in similar pediatric cases with stable lesions and open growth plates.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 43

Topic Pediatric Issues

Keywords

3rd Edition

osteochondritis dissecans

anterior knee pain

activity modification

intact articular cartilage

bony loose body

open growth plates

non-surgical management

pediatric orthopedic

knee stress reduction

conservative treatment

3rd Edition, CASE 43

Pediatric Issues