Slipped capital femoral epiphysis: Difference between revisions

Revision as of 02:20, 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

Age - 9 to 16 yrs

Present - mild to severe pain, limp

Labs - normal

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

Presentation

acute, chronic or acute on chronic slippage.
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. Whitman's sign= get abduction & ext. Rotation of hip w/ flexion of knee.

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

Authors:

@@ Line 1: / Line 1: @@
 ==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===
-- head of femur displaces from epiphysis due to loss of mechanical integrity at the growth plate
+#obesity
+#African American
-- head of femur remains in acetabulum & femoral neck rotates anter
+#male - female (2:1)
+#during growth spurt (m=13y f=11y)
-- may be seen in under 9, although uncommon (must investigate endocrinopathies in this subset)
-== ==
 ==Diagnosis==
 Age - 9 to 16 yrs
@@ Line 20: / Line 20: @@
 Labs - normal
+==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
-Presentation
+===Presentation===
+# acute, chronic or acute on chronic slippage.
+# 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.
-- acute, chronic or acute on chronic slippage.
+===PE===
+rest - foot ext rotated, hip abducted & sl flexed to decr press. hip= decr int. Rotation, abduction, flexion on PE, waddling gate. Whitman's sign= get abduction & ext. Rotation of hip w/ flexion of knee.
-- 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.
 ==DDx==
+See [[Hip Pain]]
-See Peds: Hip Pain
 ==Treatment==
+#Internal fixation
+#non wt bearing
+==Disposition==
+Admit for Ortho to pin b/c of risk of avascular necrosis w/o rx
-Internal fixation
+[[Category:Peds]]
+[[Category:Ortho]]
-***SCFE****
-*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
-*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
-(33% - mild, 34-50 % mod. )50%-sev
-*RF= obesity , AA, male - female 2- 1 (during growth spurt) m=13y f=11y
-*PE= rest - foot ext rotated, hip abducted & sl flexed to decr press. hip= decr int. Rotation, abduction, flexion on PE, waddling gate. Whitman's sign= get abduction & ext. Rotation of hip w/ flexion of knee.
-*Rx= non wt bearing & admit for Ortho to pin b/c of risk of avascular necrosis w/o rx.
-[[Category:Peds]] [[Category:Ortho]]