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Slipped Capital Femoral Epiphysis

Case Detail

Anatomy: Musculoskeletal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 5 years ago
Updated: over 5 years ago
Tags: PEDS
Modality/Study Types: CR
Activities:
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History

13 year old female with hip and knee pain.


Case Images


Diagnosis

Slipped Capital Femoral Epiphysis

Findings

CR – Widened proximal right femoral physis with blurred margins and malalignment of the femoral head and neck.

Discussion

Slipped Capital Femoral Epiphysis (SCFE) is characterized by posteromedioinferior displacement of the proximal femoral epiphysis relative to the metaphysis. This “slip” occurs through the physeal plate. SCFE is the most common hip pathology of adolescents with a prevelance of 10.8 cases per 100,000 patients. Males are more often affected with a 1.5:1 predominance over females. African Americans are affected more frequently than Caucasians. The pain associated with this condition is often poorly localized to the thigh, groin or knee. Of patients presenting with SCFE, nearly 40 percent will experience bilateral hip involvement during the course of the disease. Of this 40 percent, half will have bilateral involvement at the time of presentation. Avascular necrosis, chondrolysis and early onset osteoarthritis are among the major complications of SCFE. Proposed theories of SCFE include: obesity, rapid growth, hypothyroidism, GH supplementation, hypogonadism, renal osteodystrophy, radiation therapy, and panhypopituitarism. An underlying endocrine disorder should be considered in individuals with atypical presentations (i.e. patients that are underweight, younger than 8 or older than 15 years of age). Plain film radiography is the gold standard imaging modality in screening patients for suspected SCFE. Two of the more reliable acute radiographic findings include disruption of Klein’s line and metaphyseal blanching. Klein’s line refers to a radiographic line drawn along the superior surface of the femoral neck; a portion of the femoral epiphysis should extend above Klein’s line. Metaphyseal blanch is an area of increased density along the proximal aspect of the femoral neck due to the overlap with the epiphysis on AP radiographs.

Reference

Boles CA, El-Khoury GY. Slipped capital femoral epiphysis. Radiographics (1997); 17:809-23.

Contributor

Orrie Close
Cole Denton



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