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MRI Reveals Unseen Hip Injury in Eleven-Year-Old Boy

Hip dislocation in young boy highlights the importance of having adolescent bone and joint injuries diagnosed and treated by pediatric orthopedic specialists

NEW YORK—February 13, 2008

On a beautiful fall day in October 2006 eleven-year-old Alexander Skolds, of Greenwich, Conn., along with his other teammates, were practicing for an upcoming football game. While running with the ball, Alex was tackled and fell to the ground in severe pain. After the coaches realized that he had dislocated his hip he was immediately transported to a local hospital in suburban Connecticut. The severity of his injuries, however, would go unnoticed for days.

Alex remained in the hospital overnight for evaluation and after an X-ray and CT scan revealed that he had no serious injuries, he was sent on his way with a brace. Unfortunately, his pain persisted and at the recommendation of Peter Moley, M.D., physiatrist at Hospital for Special Surgery, who also sees patients at the HSS office in Old Greenwich, Conn., his parents took him for a second opinion at the HSS main hospital in Manhattan.

“It was a horribly rainy day and the thought of driving into the city was something I was not very excited about,” said Aileen Skolds, Alex’s mother. “Both my husband and I knew, however, that the experts at HSS would finally give us and Alex the answers we were looking for.”

After evaluating Alex’s hip and discussing the injury with him and his parents, Pediatric Orthopaedic Surgeon Daniel Green, M.D., immediately ordered an MRI to get a closer look at the hip.

“The cartilage in the joints of adolescents is still in the process of hardening and morphing into bone. Although X-ray and CT are superior at imaging bones, they cannot clearly identify potential soft tissue problems that may exist within the joints,” said Hollis Potter, M.D., chief of the Division of Magnetic Resonance Imaging in the Department of Radiology and Imaging at Hospital for Special Surgery. “MRI has superior soft tissue imaging qualities and in the case of this young boy, it was the best way to identify the problem and ultimately the source of the pain.”

The MRI revealed that Alex had suffered a significant fracture of the acetabulum—the cup of the hip joint—at the time of the hip dislocation, which was caused when the hip dislocated and was reset back to its original place. These injuries could not be seen by the initial X-ray and CT scan, but were easily observed on the MRI. Armed with this knowledge, Dr. Green immediately recommended that Alex have hip surgery to correct the problem.

“The bones and joints of adolescent children are continually changing as a child ages and his body matures,” said Dr. Green. “Because of these differences in bone structure, Alex’s injuries may have gone unnoticed had he not been seen by a pediatric orthopedic specialist. This injury would have presented major problems down the road as his problem would have become far more severe had we not properly diagnosed and treated it.”

David Helfet, M.D., an orthopedic surgeon who specializes in trauma, performed the surgery, which required open fixation of the acetabulum with plates and screws. After the procedure, Alex spent three nights at the Hospital to recover and was sent home after he could successfully manage walking and going up and down stairs with his crutches.

“Alex is now not only playing soccer, but also tearing up the basketball court and the swimming pool,” said Mrs. Skolds. “He is just like every other active and rambunctious twelve-year-old boy.”

 

About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.

 

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