1. Toxic synovitis
2. Diaphyseal femoral osteoid osteoma
3. Strep Pharyngitis.
The patient did very well with ibuprofen, however he continued to have night time symptoms that awakened him. he was switched to Naprosyn for a longer half life to allow him to sleep through the night.
He was placed on limitations of no jumping or gym class until seen at his next visit.
With proper medication adjustments and exercise limitations he had great improvement at his next visit. Follow-up X-rays showed calcification of the osteoid osteoma.
Patient did quite well with proper medication adjustments and exercise limitations. he had complete resolution in 6 weeks time of both hip and leg pain.
his follow up X-rays of the femur show calcifying of the osteoid osteoma. he returned to full activity without restrictions.
This case is not necessarily rare, but addresses two conditions that have good teaching points. number one being that a child with a fever, limp and joint pain needs to have a septic joint ruled out with emergent mri, ultrasound, and possible aspiration. Second the patients symptomatic osteoid osteoma was an unrelated symptomatic finding that if not properly examined and without good history taking may have been lumped into the hip pain. careful monitoring and maintenance would prevent this mass from being a missed osteoblastoma. If the patient was not showing improvement with said win reliever dedicated mri and likely biopsy would have been warranted.
Overall a good case with good teaching points with a classic presentation of hip synovitis.
Important in cases like this to come up with a broad differential and then let that guide your work-up, and finally important to note that while 'toxic' synovitis sounds horrible, it is usually benign and self-limiting, so transient synovitis is a more appropriate and more current name for this condition.
1.Osteoid osteoma and osteoblastoma. Includes Poll
Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H
J Am Acad Orthop Surg. 2011 Nov;19(11):678-89.
2 Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
3.AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
4. Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
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