|
Year |
2002 |
|---|---|
|
Question Number |
117. |
|
Category |
Pediatric Orthopaedics |
Question
A 12-year-old girl underwent pinning of a slipped capital femoral epiphysis of the right hip 3 years ago. At the same time, the left hip, which was normal, was pinned prophylactically as shown in Figure 23a. She was lost to follow-up for 3 years but now reports a limp, pain with weight bearing, and mild loss of motion in the left hip. The current radiograph is shown in Figure 23b. Management should now consist of
1. application of skin traction to the left lower extremity.
2. subtotal capsulectomy of the hip.
3. removal of hardware.
4. advancement of the existing screw into the femoral head.
5. revision of the screw fixation.
Figures
Answer (click for answer)
Preferred response: #5
The second image clearly demonstrates that the screw placed in the asymptomatic left hip did not cross the physis. It is therefore not stabilized and the patient’s pain is likely related to the development of a left symptomatic (unstable) SCFE. Treatment is to pin in situ—in this case revise to a lag screw into the femoral head.
Initial symptoms are often vague, but share asymmetric out-toeing gait, limp, and groin, thigh, or knee ache. Long-term outcome relates to avoidance of complications (ie. osteonecrosis) and anterior impingement.
Reference: Millis, MB and Kocher, MS. Chapter 36: Hip, Pelvis, and Femur: Pediatric Aspects, in OKU 7, Koval KJ ed, Rosemont, IL, 2002, pp. 392-393.