Slipped capital femoral epiphysis
Revision as of 02:20, 9 June 2011 by Rossdonaldson1 (talk | contribs)
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