Host: Sometimes we see a condition where kids have pain in the hip and the doctor starts analyzing the chest of the kid and he says to head of the bone going in to the -- it seems to have slipped something to the cartilage, what is that about?
Guest: There are certain hip conditions in children that are very common and a lot of that is going to depend on their age. The one that you are referring is called the slipped capital femoral epiphysis is something we tend to see in kids as they start to their adolescent growth period and about two-thirds of these kids tend to be a little heavy for their age.
Host: But for the third.
Guest: And a third are not; so the usual presentation is we have a kid that complains of either hip, groin pain, thigh pain, or even sometimes knee pain and they are limping sort of intermittently for a few weeks. Occasionally, they will come in and a knee exam will be apparently normal, but in this particular condition it's very important to identify that the problem is in the hip and not the knee. So as a general rule, the orthopedists or pediatricians, the emergency room doctors, when they have a kid come in with a limp or complaining of thigh or knee pain will always examine the hip to make sure the hip range or motion is equal on both sides. If after that evaluation, there is a concern about the hip it is very important to get X-rays to exclude this slipped condition you are talking about and the standard set of X-rays that just about orthopedist or emergency room doctor would obtain are called an AP and the frog lateral view of the pelvis.
Host: If you do diagnose it, how is it treated?
Guest: It's a condition that the prognosis of how the kids do depends a lot on how much of the slip you have. So, as soon as the condition is identified -- or my general practice is to treat it, which involves a surgery, where the kid stays overnight as soon as possible. So what I would typically do is once I have made the diagnosis, inform the parents, the kids would we put on crutches and usually within 24 or 48 hours we try and get them in to the hospital.
Host: The purpose of the surgery is to do what?
Guest: What we want to do is prevent a small problem from becoming a big problem.
Host: And you do what to it?
Guest: What's involved in the surgery is a small incision, about half-an-inch, on the front part of the upper thigh and we place under an X-ray a screw in to the bone to prevent any further slip of the hip.
Host: So basically you are making it more stable.
Guest: Right, yeah, preventing -- making it more stable and preventing progression.
Host: Suppose if you have a kid who has a hip problem and they say it is like a Toxic Synovitis, what does that term mean?
Guest: Toxic Synovitis is another problem that we see commonly in kids. It tends to been in the younger age groups and the ones we just talked about, with the slips in the adolescence. And the usual time that, that will come up as a diagnosis is the child either comes in to the emergency room or comes in to the pediatrician’s office complaining of a limp or even a refusal to put weight on their leg. Most common age range, I would say, for this is somewhere between about age two and age six and very often when we talk to these children and their families we find that either they or one of the their siblings have had a recent infection, a strep throat or an ear infection and what this Synovitis is, is inflammation and the hip is a very common place that will get this joint inflammation and so the -- what is important is that the orthopedist or the pediatrician does a whole exam and then if they think the condition that they are dealing with is a Synovitis -- once they gotten the blood tests to rule out an infection and X-rays to rule out an orthopedic problem, the children are usually put on something for inflammation and symptoms frequently resolve within a day or two.
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