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

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 J. Moley, MD, 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.”