Slipped capital femoral epiphysis: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:Epilys.jpg|thumb|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]] | |||
*Plain radiographs of the hip (bilat AP and Frog Leg views) | *Plain radiographs of the hip (bilat AP and Frog Leg views) | ||
**Widened physis (early finding) | **Widened physis (early finding) | ||
Revision as of 03:58, 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.