|
Year |
2002 |
|---|---|
|
Question Number |
64 |
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Category |
Pediatric Orthopaedics |
Question
Which of the following findings best indicates that a slipped capital femoral epiphysis can be considered stable?
1- ultrasound of the hip reveals an effusion but no metaphyseal remodeling
2- a cross-table lateral radiograph of the hip reveals a 30% slippage
3- the patient is able to walk with or without crutches
4- the patient is unable to walk with crutches but is comfortable in traction
5- an AP radiograph of the hip reveals widening of the proximal physis
Figures
Answer (click for answer)
Preferred response: 3.
SCFE is a disorder of the hip in adolescents in which there is displacement of the capital femoral epiphysis from the metaphysis through the physis. It is more commonly found in obese boys. It can be classified as pre-slip, acute (<3 weeks), acute-on-chronic or chronic. SCFE is considered stable when the child is able to walk with or without crutches. When the child cannot walk (with or without crutches) it is considered unstable. The first answer describes an acute unstable event. An ultrasound showing metaphyseal remodeling and no effusion would demonstrate a stable SCFE. The severity of SCFE can be assessed using radiographic parameters. A slip is mild when the epiphyseal-metaphyseal displacement is <33% of the width of the femoral neck or when the epiphyseal-shaft angle (measured on frog lateral) is <30 degrees. A moderate slip is 33-50% or 30-50 degrees displacement. A severe slip is >50% or >50 degrees displacement. These radiographic parameters alone do not tell you the stability of the slip. The referenced article by Loder et al is a good overview of this disease.
Reference: 1) Kallio P, Paterson DC, Foster BK, Lequesne GW: Classification in slipped capital femoral epiphysis: Sonographic assessment of stability and remodeling. Clin Orthop 1993;294:196-203. 2) Kallio PE, Mah ET, Foster BK, Paterson DC, LeQuesne GW: Slipped capital femoral epiphysis: Incidence and clinical assessment of physeal instability. J Bone Joint Surg Br 1995;77:752-755. 3) Loder RT, Aronsson DD, Dobbs MB: Slipped capital femoral epiphysis. J Bone Joint Surg Am 2000;82:1170-1188.