Patients were divided into acute and chronic cases of slipped capital femoral epiphysis
by reviewing their initial medical records: acute if the duration of symptoms was less than three weeks, and chronic if more; and if the prodromal symptoms (vague groin pain, upper or lower thigh pain, limp) were present prior to slip, it was considered as acute on chronic.
TABLE 1 Possible causes of limp in a child (1-3,17) Traumatic/mechanical Fractures, stress fractures Muscle injuries Sprains/strains Contusions Developmental dysplasia of the hip Slipped Capital femoral epiphysis
Tarsal coalition Child abuse Overuse injuries Leg length discrepancy Infectious Septic arthritis Osteomyelitis Lyme disease Psoas abscess Diskitis Inflammatory Transient synovitis Juvenile rheumatoid arthritis Ankylosing spondylitis Reiter syndrome Lupus Vascular Legg-Calve-Perthes disease Osteonecrosis Hemoglobinopathies (sickle cell disease) Neoplastic Leukemia, lymphoma Malignant/lyric tumors (Ewing sarcoma, osteogenic sarcoma, etc.
Compensating osteotomy at the base of the femoral neck for slipped capital femoral epiphysis
There are 2 femoral head disorders that commonly affect Children and adolescents: Avascular necrosis of the femoral head and slipped capital femoral epiphysis
Measurement using Klein's line (depicted on films) revealed posteromedial displacement of the capital femoral epiphysis
on the metaphysis of the right femur.
More serious adverse events include intracranial hypertension, diabetic retinopathy, slipped capital femoral epiphysis
, progression of preexisting scoliosis, and sudden death in some pediatric patients with Prader-Willi syndrome.
Imaging revealed break in the shentons line, capital femoral epiphysis
was atrophic and displaced to upper-outer quadrant of reference lines.
Diagnosis: Bilateral slipped capital femoral epiphysis
Keep in mind that slipped capital femoral epiphysis
can present as knee pain, so check hip internal rotation.
Aside from having a thorough patellar exam, athletes with suspected PFS should undergo a full structural exam--including a careful examination of the hip--to rule out a slipped capital femoral epiphysis
Several investigators have shown relative success in hip resurfacing for patients exhibiting childhood disorders, including developmental dysplasia of the hip, slipped capital femoral epiphysis
, and Legg-Calve-Perthes disease, (8-9) while others have shown disappointing results, specifically in the placement and longevity of the femoral component in such cases.
Such hip impairments may arise from a slipped capital femoral epiphysis
(SCFE), which occurs in up to 2% of the pediatric population.