Slipped capital femoral epiphysis: Difference between revisions
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===Risk Factors=== | ===Risk Factors=== | ||
*Obesity | *Obesity | ||
*Black | *Black race | ||
*Male:female | *Male sex (male:female 3:1) | ||
* | *Times of high growth velocity (male growth spurt, around 13 years; female growth spurt, around 11 years) | ||
*Left hip more common | *Left hip more common | ||
* | *Endocrine disorders | ||
**[[Hypothyroid]] common | **[[Hypothyroid]] common | ||
** | **High clinical concern for SCFE in children less than <10 yrs of age | ||
==Clinical Features== | ==Clinical Features== | ||
*Mild to severe pain [[Pediatric hip pain|hip pain]] | *Mild to severe pain [[Pediatric hip pain|hip pain]] | ||
* | **Often present with referred [[knee pain]] | ||
*[[Limp (Peds)|Limp]] | *Abnormal gait | ||
* | **[[Limp (Peds)|Limp]] | ||
* | **Weakness | ||
*May present as acute, chronic, or acute on chronic (following trauma) | **Thigh atrophy | ||
*Externally rotated hip | |||
**Loss of internal rotation | |||
**Loss of abduction | |||
**Loss of flexion | |||
*May present as acute (unstable), chronic (stable), or acute on chronic (following trauma) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Epilys.jpg|thumb|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]] | [[File:Epilys.jpg|thumb|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]] | ||
*Plain radiographs of the hip ( | [[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).]] | ||
*Plain radiographs of the hip (bilateral AP and frog-leg views) | |||
**Widened physis (early finding) | **Widened physis (early finding) | ||
**Displacement of femoral neck to head (late finding) | **Displacement of femoral neck to head (late finding, so called 'ice cream cone' sign) | ||
** | **May show necrosis of the femoral head in late cases complicated by avascular necrosis | ||
**Note that up to 40% of patients will 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 | ||
**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 | ||
***If does not cross the femoral head, highly suspicious for SCFE | |||
*May require MRI in ambiguous cases | *May require MRI in ambiguous cases | ||
==Management== | ==Management== | ||
*Orthopedic surgery consultation in ED | *Orthopedic surgery consultation in ED | ||
* | *Strict non-weight bearing | ||
*Pain control | |||
*Internal fixation | *Internal fixation | ||
**Performed immediately for unstable SCFE | |||
**May be delayed by a few days for stable SCFE | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 19:10, 8 August 2019
Background
- Abbreviation: SCFE
- Most common cause of hip disability in adolescents
- Head of femur displaces from epiphysis
- Common complications: avascular necrosis of femoral head (increased risk with high grade slip), arthritis
Risk Factors
- Obesity
- Black race
- Male sex (male:female 3:1)
- Times of high growth velocity (male growth spurt, around 13 years; female growth spurt, around 11 years)
- Left hip more common
- Endocrine disorders
- Hypothyroid common
- High clinical concern for SCFE in children less than <10 yrs of age
Clinical Features
- Mild to severe pain hip pain
- Often present with referred knee pain
- Abnormal gait
- Limp
- Weakness
- Thigh atrophy
- Externally rotated hip
- Loss of internal rotation
- Loss of abduction
- Loss of flexion
- May present as acute (unstable), chronic (stable), 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 (bilateral AP and frog-leg views)
- Widened physis (early finding)
- Displacement of femoral neck to head (late finding, so called 'ice cream cone' sign)
- May show necrosis of the femoral head in late cases complicated by avascular necrosis
- Note that up to 40% of patients will 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
- If does not cross the femoral head, highly suspicious for SCFE
- May require MRI in ambiguous cases
Management
- Orthopedic surgery consultation in ED
- Strict non-weight bearing
- Pain control
- Internal fixation
- Performed immediately for unstable SCFE
- May be delayed by a few days for stable SCFE
Disposition
- Admit
External Links
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.