ORTHOPAEDICS


Case 10 :
A 15-year-old athletic boy presents with right hip pain. What is the diagnosis?

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Imaging Findings
The right epiphysis has slipped postero-medially with respect to the metaphysis. Marginal widening of the epiphyseal plate is noted.

Diagnosis
Slipped Capital Femoral Epiphysis

Discussion
Slipped capital femoral epiphysis (SCFE) occurs typically between the ages of 10 and 17 in boys and 8 and 15 in girls. It is believed that trauma may play a role in the development of SCFE, especially in younger children. Other factors include hypothyroidism, acromegaly, gigantism, as well as other pituitary and parathyroid causes. There is a higher incidence of SCFE in obese adolescents that may cause an increase in shearing forces on the growth plate even during normal daily activity.

X-ray Findings
In the AP view, a line drawn along the superior femoral neck should pass through the femoral head and the medial contour of the head and neck should describe a pass through the femoral head, and the medial contour of the head and neck should describe a continuous arc. With early slipping, the epiphyseal plate will be widened and the epiphysis will appear somewhat shortened on the affected side. On the frog-leg lateral view, the degree of posterior epiphyseal displacement is generally easily seen while often still not apparent on the AP view. Sequaelae of SCFE include osteonecrosis, chondrolysis, and degenerative joint disease.

References

1

Dr. Sanjeev Mani, Bandra Holy Family Hospital, Mumbai

 

 


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