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What is the most concerning statement by a child with a newly placed long leg cast after repair of the tibia?

The correct answer is d. Frequent serial casting is tried first

Choice A reason:

Infants do not outgrow clubfoot on their own. Without treatment, the condition can lead to significant disability and difficulty walking. Early intervention is crucial to correct the deformity and ensure proper foot function.

Choice B Reason:

Surgical intervention is not the first line of treatment for mild cases of clubfoot. Surgery is typically reserved for severe cases or when nonsurgical methods, such as casting, have failed. The goal is to correct the foot’s position using less invasive methods whenever possible.

Choice C Reason:

Traction with foot manipulation is not a standard treatment for clubfoot. The primary nonsurgical treatment involves the Ponseti method, which includes gentle manipulation and serial casting to gradually correct the foot’s position.

Choice D Reason:

Frequent serial casting, known as the Ponseti method, is the first line of treatment for clubfoot. This method involves weekly manipulation and casting of the foot to gradually move it into the correct position. It is highly effective and is the preferred initial treatment for most cases of clubfoot.

Choice A reason:

Compartment syndrome is a condition where increased pressure within a muscle compartment leads to decreased blood flow, which can cause muscle and nerve damage. It is typically associated with severe trauma, fractures, or crush injuries. The symptoms include severe pain, swelling, and decreased sensation or movement in the affected limb. In this case, the child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are more indicative of an infection rather than compartment syndrome.

Choice B Reason:

Osteomyelitis is an infection of the bone, which can occur following an injury or infection elsewhere in the body. The symptoms include redness, swelling, tenderness, and pain in the affected area, along with fever and elevated WBC. Given the child’s history of a spider bite and the presence of redness, swelling, tenderness, and elevated WBC, osteomyelitis is the most likely diagnosis. The unremarkable X-ray does not rule out osteomyelitis, as early stages of the infection may not show changes on X-ray.

Choice C Reason:

Osteogenesis imperfecta, also known as brittle bone disease, is a genetic disorder characterized by fragile bones that break easily. It is not associated with infections or elevated WBC. The symptoms of osteogenesis imperfecta include frequent fractures, blue sclerae, and hearing loss. The child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are not consistent with osteogenesis imperfecta.

Choice D Reason:

Juvenile idiopathic arthritis (JIA) is a type of arthritis that occurs in children. It is characterized by persistent joint inflammation, pain, and swelling. While JIA can cause joint tenderness and swelling, it is not typically associated with a recent injury or infection, such as a spider bite. Additionally, JIA does not usually cause elevated WBC. The child’s symptoms are more indicative of an infection, making osteomyelitis the more likely diagnosis.