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Orthopedics
miscellaneous
legg-calve-perthes
A 7-year-old boy is brought to the orthopedic clinic by his parents due to a progressive limp and discomfort in his right hip. The symptoms began subtly about a month ago, initially intermittent, but have become more persistent and are now affecting his participation in school activities. He denies any recent trauma or fever. His medical history is unremarkable, and he is up to date on immunizations. On physical examination, his temperature is 36.8°C, blood pressure 105/65 mmHg, pulse 88/min, and respirations 18/min. He exhibits an antalgic gait, favoring his right leg. Passive range of motion of the right hip is limited, particularly with abduction and internal rotation, and he reports mild pain at the extremes of motion. There is subtle disuse atrophy of the right thigh musculature compared to the left. Peripheral pulses are strong and symmetric. Radiographs of the pelvis and right hip are obtained. Based on the clinical presentation and initial imaging findings, what is the most probable diagnosis and the appropriate initial management approach?
| Lab Parameter | Value | Reference Range |
|---|---|---|
| Erythrocyte Sedimentation Rate (ESR) | 5 mm/hr | < 15 mm/hr |
| C-reactive protein (CRP) | 0.8 mg/L | < 5.0 mg/L |

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