Slipped capital femoral epiphysis: Difference between revisions
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*AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009 | *AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009 | ||
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[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 16:00, 22 March 2016
Background
- Most common cause of hip disability in adolescents
- Head of femur displaces from epiphysis
- Complications: avascular necrosis, arthritis
Risk Factors
- Obesity
- African-American
- Male:female (3:1)
- During growth spurt (m=13y f=11y)
- L Hip more common
- Associated w/ 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
- 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:
Diagnosis
- AP, Frog Leg Lateral View B/L
- Widened physis (early finding)
- Displacement of femoral neck to head (late finding)
- Frog Leg view of both sides: high proportion have b/l involvement
- Klein's line
- Line from superior cortex of femoral neck parallel to greater trochanter
- Normally should cross through 1/3 of femoral head
- Line from superior cortex of femoral neck parallel to greater trochanter
Treatment
- Orthopedic consultation in ED; pinning
- MRI for ambiguous cases
- Non-weight bearing
- Internal fixation
Common Complications
- osteonecrosis of femoral head; increased risk with high grade slip
- contralateral SCFE
Disposition
Admission
See Also
References
- Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
- AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009