Slipped capital femoral epiphysis: Difference between revisions
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**Frog Leg view of both sides: up to 40% have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | **Frog Leg view of both sides: up to 40% have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | ||
*Klein's line | *Klein's line | ||
[[File:PMC4063129 ISRN.ORTHOPEDICS2011-486512.001.png|thumb| A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).]] | |||
**Line from superior cortex of femoral neck parallel to greater trochanter | **Line from superior cortex of femoral neck parallel to greater trochanter | ||
**Normally should cross through 1/3 of femoral head | **Normally should cross through 1/3 of femoral head | ||
Revision as of 04:05, 17 May 2017
Background
- Abbreviation: SCFE
- Most common cause of hip disability in adolescents
- Head of femur displaces from epiphysis
- Complications: avascular necrosis, arthritis
Risk Factors
- Obesity
- Black patients
- Male:female (3:1)
- During growth spurt (m=13y f=11y)
- Left hip more common
- Associated with endocrine disorders
- Hypothyroid common
- high clinical concern for <10 yrs of age
Clinical Features
- Mild to severe pain hip pain (may have referred knee pain)
- abnormal gait
- Limp, weakness, thigh atrophy
- externally rotated hip
- loss of internal rotation, abduction, and flexion
- May present as acute, chronic, or acute on chronic (following trauma)
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Evaluation
- Plain radiographs of the hip (bilat AP and Frog Leg views)
- Widened physis (early finding)
- Displacement of femoral neck to head (late finding)
- Frog Leg view of both sides: up to 40% have bilateral involvement [1]
- Klein's line
- Line from superior cortex of femoral neck parallel to greater trochanter
- Normally should cross through 1/3 of femoral head
- May require MRI in ambiguous cases
Management
- Orthopedic surgery consultation in ED
- Non-weight bearing
- Internal fixation
Disposition
- Admit
Common Complications
- Avascular necrosis of femoral head; increased risk with high grade slip
- Contralateral SCFE
See Also
References
- ↑ Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.