Slipped capital femoral epiphysis: Difference between revisions

Revision as of 03:53, 27 June 2011

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)

Diagnosis

Presentation

Mild to severe pain hip pain (may have referred knee pain)
Limp
May present as acute, chronic, or acute on chronic (following trauma)

Imaging

AP and lateral (bilateral)
- Widened physis (early finding)
- Displacement of femoral neck to head (late finding)
Klein's line
- Line from superior cortex of femoral neck parallel to greater trochanter
  - Normally should cross through 1/3 of femoral head

Treatment

Orthopedic consultation in ED
MRI for ambiguous cases
Non-weight bearing
Internal fixation

Disposition

Admission

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*head of femur displaces from epiphysis due to loss of mechanical integrity at the growth plate
+*Most common cause of hip disability in adolescents
-*head of femur remains in acetabulum & femoral neck rotates anter
+*Head of femur displaces from epiphysis
-*may be seen in under 9, although uncommon (must investigate endocrinopathies in this subset)
+*Complications: avascular necrosis, arthritis
-*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===
+==Risk Factors==
-#obesity
+#Obesity
-#African American
+#African-American
-#male - female (2:1)
+#Male:female (3:1)
-#during growth spurt (m=13y f=11y)
+#During growth spurt (m=13y f=11y)
 ==Diagnosis==
 ===Presentation===
-#Age - 9 to 16 yrs
+*Mild to severe pain hip pain (may have referred knee pain)
-# mild to severe pain, limp
+*Limp
-# acute, chronic or acute on chronic slippag
+*May present as acute, chronic, or acute on chronic (following trauma)
-# pts tend to be overweight
+===Imaging===
-# limited range of motion on int rot Xrays
+*AP and lateral (bilateral)
-# widened epiphyseal plate & displacement of femoral neck to head.
+**Widened physis (early finding)
-# complications include jt space narrowing, arthritis & avascular necrosis of hip.
+**Displacement of femoral neck to head (late finding)
+*Klein's line
+**Line from superior cortex of femoral neck parallel to greater trochanter
+***Normally should cross through 1/3 of femoral head
-===PE===
+==Treatment==
-#rest - foot ext rotated, hip abducted & sl flexed to decr press.
+*Orthopedic consultation in ED
-#hip= decr int. Rotation, abduction, flexion on PE, waddling gate.
+*MRI for ambiguous cases
+*Non-weight bearing
+*Internal fixation
-==Workup==
+==Disposition==
-*Xray - Anterior displacement of femoral neck to head
+Admission
-**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==
+==See Also==
-#Internal fixation
+[[Hip Pain]]
-#non wt bearing
-==Disposition==
+==Source==
-Admit for Ortho to pin b/c of risk of avascular necrosis w/o rx
+Tintinalli
 [[Category:Peds]]
 [[Category:Ortho]]