Approach to a limp (pediatrics) Quiz: Ace Your Exams

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A 6-year-old boy presents to the pediatric clinic with a six-week history of limping noticed by his parents and pain in the right groin while walking. The parents report no recent trauma or fever or illness. Past medical history is unremarkable. Temperature is 36.8°C (98.2°F), heart rate is 72/min, respiratory rate is 18/min, blood pressure is 100/60 mm Hg, and oxygen saturation is 98% on room air. Physical examination shows the patient walking with a slight limp. There is limited range of motion in the right hip joint with internal rotation and abduction. There is pain with passive movement of the right hip. The rest of the musculoskeletal examination is unremarkable. Laboratory evaluation including complete blood count, erythrocyte sedimentation rate and C-reactive protein is unremarkable. Bilateral hip radiograph is shown below. Which of the following is the most likely diagnosis?

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