Slipped capital femoral epiphysis - Revision history

Rossdonaldson1: /* Evaluation */

2019-08-08T19:10:37Z

Evaluation

← Older revision		Revision as of 19:10, 8 August 2019
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	==Evaluation==		==Evaluation==
	[[File:Epilys.jpg\|thumb\|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]]		[[File:Epilys.jpg\|thumb\|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]]
			[[File:PMC4063129 ISRN.ORTHOPEDICS2011-486512.001.png\|thumb\| A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).]]
	*Plain radiographs of the hip (bilateral AP and frog-leg views)		*Plain radiographs of the hip (bilateral AP and frog-leg views)
	**Widened physis (early finding)		**Widened physis (early finding)
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	**Note that up to 40% of patients will have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>		**Note that up to 40% of patients will have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
	*Klein's line		*Klein's line
	[[File:PMC4063129 ISRN.ORTHOPEDICS2011-486512.001.png\|thumb\| A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).]]
	**Line from superior cortex of femoral neck parallel to greater trochanter		**Line from superior cortex of femoral neck parallel to greater trochanter
	**Normally should cross through 1/3 of femoral head		**Normally should cross through 1/3 of femoral head

SLuckettG: /* Management */

2019-03-25T20:20:34Z

Management

← Older revision		Revision as of 20:20, 25 March 2019
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	==Management==		==Management==
	*Orthopedic surgery consultation in ED		*Orthopedic surgery consultation in ED
	*~~Non~~-weight bearing		*Strict non-weight bearing
			*Pain control
	*Internal fixation		*Internal fixation
			**Performed immediately for unstable SCFE
			**May be delayed by a few days for stable SCFE

	==Disposition==		==Disposition==

SLuckettG: /* Evaluation */

2019-03-25T20:19:54Z

Evaluation

← Older revision		Revision as of 20:19, 25 March 2019
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	==Evaluation==		==Evaluation==
	[[File:Epilys.jpg\|thumb\|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]]		[[File:Epilys.jpg\|thumb\|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]]
	*Plain radiographs of the hip (~~bilat~~ AP and ~~Frog Leg~~ views)		*Plain radiographs of the hip (bilateral AP and frog-leg views)
	**Widened physis (early finding)		**Widened physis (early finding)
	**Displacement of femoral neck to head (late finding)		**Displacement of femoral neck to head (late finding, so called 'ice cream cone' sign)
	**~~Frog Leg view~~ of ~~both sides:~~ up to 40% have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>		**May show necrosis of the femoral head in late cases complicated by avascular necrosis
			**Note that up to 40% of patients will have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
	*Klein's line		*Klein's line
	[[File:PMC4063129 ISRN.ORTHOPEDICS2011-486512.001.png\|thumb\| A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).]]		[[File:PMC4063129 ISRN.ORTHOPEDICS2011-486512.001.png\|thumb\| A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).]]
	**Line from superior cortex of femoral neck parallel to greater trochanter		**Line from superior cortex of femoral neck parallel to greater trochanter
	**Normally should cross through 1/3 of femoral head		**Normally should cross through 1/3 of femoral head
			***If does not cross the femoral head, highly suspicious for SCFE
	*May require MRI in ambiguous cases		*May require MRI in ambiguous cases

SLuckettG: /* Clinical Features */

2019-03-25T20:18:05Z

Clinical Features

← Older revision		Revision as of 20:18, 25 March 2019
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	==Clinical Features==		==Clinical Features==
	*Mild to severe pain [[Pediatric hip pain\|hip pain]] ~~(may have~~ referred [[knee pain]])		*Mild to severe pain [[Pediatric hip pain\|hip pain]]
	*~~abnormal~~ gait		**Often present with referred [[knee pain]]
	*[[Limp (Peds)\|Limp]]~~, weakness, thigh~~ atrophy		*Abnormal gait
	*~~externally~~ rotated hip		**[[Limp (Peds)\|Limp]]
	*~~loss~~ of internal rotation, abduction~~, and~~ flexion		**Weakness
	*May present as acute, chronic, or acute on chronic (following trauma)		**Thigh atrophy
			*Externally rotated hip
			**Loss of internal rotation
			**Loss of abduction
			**Loss of flexion
			*May present as acute (unstable), chronic (stable), or acute on chronic (following trauma)

	==Differential Diagnosis==		==Differential Diagnosis==

SLuckettG: /* Risk Factors */

2019-03-25T20:16:54Z

Risk Factors

← Older revision		Revision as of 20:16, 25 March 2019
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	===Risk Factors===		===Risk Factors===
	*Obesity		*Obesity
	*Black ~~patients~~		*Black race
	*Male:female (3:1)		*Male sex (male:female 3:1)
	*~~During~~ growth spurt ~~(m=13y f=11y~~)		*Times of high growth velocity (male growth spurt, around 13 years; female growth spurt, around 11 years)
	*Left hip more common		*Left hip more common
	*~~Associated with endocrine~~ disorders		*Endocrine disorders
	**[[Hypothyroid]] common		**[[Hypothyroid]] common
	**~~high~~ clinical concern for <10 yrs of age		**High clinical concern for SCFE in children less than <10 yrs of age

	==Clinical Features==		==Clinical Features==

Mholtz at 23:45, 21 May 2018

2018-05-21T23:45:37Z

← Older revision		Revision as of 23:45, 21 May 2018
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	*Most common cause of hip disability in adolescents		*Most common cause of hip disability in adolescents
	*Head of femur displaces from epiphysis		*Head of femur displaces from epiphysis
	*~~Complications~~: [[avascular necrosis]], [[arthritis]]		*Common complications: [[avascular necrosis]] of femoral head (increased risk with high grade slip), [[arthritis]]

	===Risk Factors===		===Risk Factors===
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	*Admit		*Admit

	==~~Common Complications~~==		==External Links==
	*[[Avascular necrosis]] of femoral head; increased risk with high grade slip
	*Contralateral SCFE

	==See Also==		==See Also==

Rossdonaldson1: /* Evaluation */

2017-05-17T04:05:55Z

Evaluation

← Older revision		Revision as of 04:05, 17 May 2017
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	**Frog Leg view of both sides: up to 40% have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>		**Frog Leg view of both sides: up to 40% have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
	*Klein's line		*Klein's line
			[[File:PMC4063129 ISRN.ORTHOPEDICS2011-486512.001.png\|thumb\| A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).]]
	**Line from superior cortex of femoral neck parallel to greater trochanter		**Line from superior cortex of femoral neck parallel to greater trochanter
	**Normally should cross through 1/3 of femoral head		**Normally should cross through 1/3 of femoral head

Rossdonaldson1: /* Evaluation */

2017-05-17T03:58:58Z

Evaluation

← Older revision		Revision as of 03:58, 17 May 2017
Line 27:		Line 27:

	==Evaluation==		==Evaluation==
			[[File:Epilys.jpg\|thumb\|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]]
	*Plain radiographs of the hip (bilat AP and Frog Leg views)		*Plain radiographs of the hip (bilat AP and Frog Leg views)
	**Widened physis (early finding)		**Widened physis (early finding)

Rossdonaldson1 at 03:54, 17 May 2017

2017-05-17T03:54:56Z

← Older revision		Revision as of 03:54, 17 May 2017
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	*Non-weight bearing		*Non-weight bearing
	*Internal fixation		*Internal fixation

			==Disposition==
			*Admit

	==Common Complications==		==Common Complications==
	*[[Avascular necrosis]] of femoral head; increased risk with high grade slip		*[[Avascular necrosis]] of femoral head; increased risk with high grade slip
	*Contralateral SCFE		*Contralateral SCFE

	~~==Disposition==~~
	*Admit

	==See Also==		==See Also==

Rossdonaldson1: /* Evaluation */

2017-05-17T03:54:35Z

Evaluation

← Older revision		Revision as of 03:54, 17 May 2017
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	**Widened physis (early finding)		**Widened physis (early finding)
	**Displacement of femoral neck to head (late finding)		**Displacement of femoral neck to head (late finding)
	**Frog Leg view of both sides: up to 40% have ~~b/l~~ involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>		**Frog Leg view of both sides: up to 40% have bilateral involvement <ref name="Pediatric orthopedic emergencies">Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
	*Klein's line		*Klein's line
	**Line from superior cortex of femoral neck parallel to greater trochanter		**Line from superior cortex of femoral neck parallel to greater trochanter