Exam MCCQE Topic 1 Question 288 Discussion

This presentation best fits osteomyelitis, likely subacute given the 2-week course and radiographic metaphyseal sclerosis. MCCQE objectives stress that fever, systemic malaise, and elevated inflammatory markers (CRP above normal) with localized limb pain/limp should prompt consideration of bone infection even if the child can still weight-bear. Osteomyelitis in children commonly involves the metaphysis of long bones due to vascular anatomy; early x-rays may be normal, but with time they can show periosteal reaction or sclerosis. In contrast, transient synovitis typically occurs after a viral illness, is usually afebrile or minimally febrile, and inflammatory markers are often normal. Legg-Calve-Perthes is classically age 4-8 and affects the femoral epiphysis/head with avascular necrosis changes rather than metaphyseal sclerosis and systemic illness. SCFE presents in adolescents with limp and limited internal rotation/obligate external rotation, usually without fever or elevated CRP, and x-ray shows epiphyseal slip. An undisplaced fracture would usually have trauma history and not systemic features.