Hip Disorders

Posted by e-Medical PPT
Slipped capital femoral epiphysis (SCFE)Traumatic hip dislocation
Osteoarthritis

"Slipped upper femoral epiphysis" is a medical term referring to slippage of the overlying epiphysis of proximal femur posteriorly and inferiorly due to weakness of the growth plate. Most often, it develops during periods of accelerated growth, shortly after the onset of puberty.
A Klein line is a line drawn along the superior border of the femoral neck that would normally pass through a portion of the femoral head. If not, slipped capital femoral epiphysis is diagnosed.
The patient's left hip (arrow) shows that a slight shift of the head of the femur occurred through the growth plate.

Risk Factors
Most common in the adolescent period (boys aged 10-16 y, girls aged 12-14 y).
Males have 2.4 times the risk as females.
Obesity is a risk factor because it places more shear forces around the proximal growth plate in the hip at risk.
Bilateral slippage is common (but the left hip is affected more commonly than the right).

Etiology
Overweight
Endocrine disorders (e.g adiposogenital dystrophy, primary or secondary hypothyroidism).
Deficiency or increase of androgens.
Acute trauma.
Slipping of the upper femoral epiphysis occurs predominantly in obese children with underdeveloped sexual characteristics and less commonly, in tall, thin children.

Pathology
The slip occurs in the hypertrophic zone of the growth plate.
70% slow and progressive (This is gradual, with slowly     increasing symptoms over a period of weeks or even months. In chronic slipping, there may be no history of trauma and the symptoms are often quite mild).
30% acute due to trauma (Least common, this usually follows severe trauma such as a fall from a height ).
If the slip is sever anterior retinacular vessels are torn → avascular necrosis.
Physeal slip → premature fusion of the epiphysis within 2 years.

Clinical Features
1.  Pain : in the groin and around the knee.
2.  Limp (intermittent).
3.  Shortening of the affected limb (1-2 cm).
4.  The limb is in external rotation.
5.  Flexion, abduction, medial rotation are limited.
6.  External rotation, adduction are increased.

Diagnosis
The diagnosis is a combination of clinical suspicion plus radiological investigation. 20-50% of SCFE are missed or misdiagnosed on their first presentation to a medical facility. This is because the common symptom is knee pain. This is referred pain from the hip. The knee is investigated and found to be normal
Ultra sound :
AP X-ray : (melting ice cream cone)
 1. Widening of the growth plate.
 2. Trethowan’s sign : Line up superior margin of neck should intersect epiphysis (usually 20% of the femoral head lateral to this line)
 3. Capeners sign : In pelvic AP view in the normal hip, the posterior acetabular margin cuts across the medial corner of the upper femoral metaphysis. With slipping, the entire metaphysis is lateral to the posterior acetabular margin
Lateral X-ray :
 Slip
 Posterior horn of the neck is lower than anterior horn....

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