Slipped capital femoral epiphysis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Presentation=== | ===Presentation=== | ||
# acute, chronic or acute on chronic | #Age - 9 to 16 yrs | ||
# mild to severe pain, limp | |||
# acute, chronic or acute on chronic slippag | |||
# pts tend to be overweight | # pts tend to be overweight | ||
# limited range of motion on int rot Xrays | # limited range of motion on int rot Xrays | ||
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===PE=== | ===PE=== | ||
rest - foot ext rotated, hip abducted & sl flexed to decr press. hip= decr int. Rotation, abduction, flexion on PE, waddling gate | #rest - foot ext rotated, hip abducted & sl flexed to decr press. | ||
#hip= decr int. Rotation, abduction, flexion on PE, waddling gate. | |||
==Workup== | ==Workup== | ||
Xray - Anterior displacement of femoral neck to head | *Xray - Anterior displacement of femoral neck to head | ||
**Loenstein (frog leg) view & AP views | |||
*Loenstein (frog leg) view & AP views | **Kleines Line - line from sup cortex of femoral neck parallel to greater trochanter, nl= should cross thru 1/3 of fem head, scfe does'nt. | ||
*Kleines Line - line from sup cortex of femoral neck parallel to greater trochanter, nl= should cross thru 1/3 of fem head, scfe does'nt. | **X - ray - early - widened physis (B4 actual slip) if not sure do bone scan | ||
*X - ray - early - widened physis (B4 actual slip) if not sure do bone scan | |||
Labs - normal | Labs - normal | ||
Revision as of 02:54, 9 June 2011
Background
- head of femur displaces from epiphysis due to loss of mechanical integrity at the growth plate
- head of femur remains in acetabulum & femoral neck rotates anter
- may be seen in under 9, although uncommon (must investigate endocrinopathies in this subset)
- d/t slip of proximal femoral epiphysis post & inf on the metaphysis thru physeal plate during growth spurt
- 20% - 25% rate of opp hip involvement - 2/3 present at same time
- (33% - mild, 34-50 % mod. )50%-sev
Risk Factors
- obesity
- African American
- male - female (2:1)
- during growth spurt (m=13y f=11y)
Diagnosis
Presentation
- Age - 9 to 16 yrs
- mild to severe pain, limp
- acute, chronic or acute on chronic slippag
- pts tend to be overweight
- limited range of motion on int rot Xrays
- widened epiphyseal plate & displacement of femoral neck to head.
- complications include jt space narrowing, arthritis & avascular necrosis of hip.
PE
- rest - foot ext rotated, hip abducted & sl flexed to decr press.
- hip= decr int. Rotation, abduction, flexion on PE, waddling gate.
Workup
- Xray - Anterior displacement of femoral neck to head
- Loenstein (frog leg) view & AP views
- Kleines Line - line from sup cortex of femoral neck parallel to greater trochanter, nl= should cross thru 1/3 of fem head, scfe does'nt.
- X - ray - early - widened physis (B4 actual slip) if not sure do bone scan
Labs - normal
DDx
See Hip Pain
Treatment
- Internal fixation
- non wt bearing
Disposition
Admit for Ortho to pin b/c of risk of avascular necrosis w/o rx