CASE 87

By: Dr. Aliya Sarhan Al Barwani.

HISTORY: With held.

What are the findings?

What is the diagnosis?

What is the common complications if left untreated?

FINDINGS:

Pelvic X-ray, AP view: Mild widening and irregularity of the left growth plate.

Klien’s line is not intersecting the left femoral epiphysis.

DIAGNOSIS:

Slipped Capital Femoral Epiphysis (SCFE).

The most common complications are degenerative changes and osteonecrosis of the femoral epiphysis.

PEARLS AND DISCUSSION:

Is a Salter-Harris Type I fracture through the physeal plate of the proximal femur resulting in posteromedial displacement. It should be suspected in any adolescent who complains of hip or knee pain. Obesity is a risk factor and commonly seen in boys. It is seen bilateral about 20%.

Plain Radiograph, AP is the modality of choice:

Early phase: Plan Radiograph will show widening, irregularity and blurring of the physeal plate with irregular and osteopenic metaphysis. Klein’s line: a line drawn along the lateral edge of the femoral neck fails to intersect the epiphysis during the acute phase.

Later phase: Posteromedial displacement with apparent collapse of the epiphysis. Frog View will confirm the findings of slip epiphysis.

Treatment is by surgical pinning to avoid degenerative changes and osteonecrosis.

FURTHER READING:

1.      Boles CA and el-Khoury GY. Slipped capital femoral epiphysis. Radiographics. (1997)

2.      Gholve PA and Cameron DB. Slipped capital femoral epiphysis update. Curr Opin Pediatr. (2009)

3.      Peck D. Slipped capital femoral epiphysis: diagnosis and management. Am Fam Physician. (2010)

4.      Gekeler J. Radiology of adolescent slipped capital femoral epiphysis: measurement of epiphyseal angles and diagnosis. Oper Orthop Traumatol. (2007)