A 15-year-old boy is brought to the physician because of left-sided groin pain and difficulty walking for 3 weeks. He reports having pain at rest and increased pain with activity. He recently started playing flag football but does not recall any trauma. Medical history is significant for sickle cell disease. He is at the 25th percentile for height and 20th percentile for weight. His temperature is 37.0°C (98.6°F), pulse is 90/min, and blood pressure is 120/80 mm Hg. Examination shows tenderness over the lateral aspect of the left hip with no swelling, warmth, or erythema. There is a decrease in an active and passive internal and external rotation, extension, and abduction. Imaging of the hip is shown in the exhibit. Which of the following is the most likely cause of this patient's pain?

Question

A 15-year-old boy is brought to the physician because of left-sided groin pain and difficulty walking for 3 weeks. He reports having pain at rest and increased pain with activity. He recently started playing flag football but does not recall any trauma. Medical history is significant for sickle cell disease. He is at the 25th percentile for height and 20th percentile for weight. His temperature is 37.0°C (98.6°F), pulse is 90/min, and blood pressure is 120/80 mm Hg. Examination shows tenderness over the lateral aspect of the left hip with no swelling, warmth, or erythema. There is a decrease in an active and passive internal and external rotation, extension, and abduction.  Imaging of the hip is shown in the exhibit.  Which of the following is the most likely cause of this patient's pain?

Quizplus · Accepted Answer

Eductional Objective: Osteonecrosis (avascular necrosis) occurs due to disruption of the macrovasculature or microvasculature of bone.  The femoral head is the most common location.  Sickle cell disease can cause osteonecrosis due to the thrombotic occlusion of arteries.  Other major risk factors include embolic disorders, high-dose systemic corticosteroids, excessive alcohol use, vasculitis (eg, systemic lupus erythematosus), and femoral neck fracture.

A 15-Year-Old Boy Is Brought to the Physician Because of Left-Sided