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Lytic Lesion in the Distal Femur

William J. Otto, MD
JAMA. 1965;194(7):729-730. doi:10.1001/jama.1965.03090200037010.
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Dr. Bruce J. Haskin:  An 8-year-old white girl was admitted complaining of pain in her right knee. Three months prior to admission she fell and struck her right knee, producing pain which was increased by walking and caused a slight limp. The pain gradually decreased until about three weeks prior to admission when she again fell, resulting in increased pain in her knee and limitation of motion. She was otherwise well.Physical examination revealed a blood pressure of 110/70 mm Hg respirations, 16; pulse rate 80 beats per minute, and temperature 99 F (37.2 C). The right knee was moderately swollen, warm, and nontender. There was fluid in the joint, but no bony abnormality could be palpated. Full flexion was slightly limited.The white blood cell count was 10,800, with 65% polymorphonuclear cells and 9% band cells. Hematocrit reading was 40%. Sedimentation rate was normal. The roentgenograms (Figure) were interpreted


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