Presentation
Atraumatic right hip pain. No red flag signs or symptoms. Pain on movement of the right hip and reduced range of motion.
Patient Data
Sclerosis and flattening of the right femoral epiphysis. Otherwise normal appearance. The child is very young for avascular necrosis, but that is in the differential along with Meyer dysplasia.
In 1 year, there has been very little change and there is no fragmentation. The ossification of the femoral head is atypical with nodularity. Features are more in keeping with Meyer dysplasia.
Case Discussion
A small, dense femoral epiphysis should always make you think of avascular necrosis (Perthes disease if idiopathic). However, where there is no change, and the femoral head as an apparent nodularity to the ossification, Meyer dysplasia is a good differential.
The nodularity of ossification is sometimes termed "morulated" which derives from cleavage and separation in embryology but is rarely used in clinical practice.
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