Slipped capital femoral epiphysis

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Right hip pain

Patient Data

Age: 11 years
Gender: Female
Modality: MRI

Diffuse widening of the physis on coronal and axial T1-weighted images with diffuse widening of intermediate signal intensity circumscribed by a linear low signal margin.

Posteromedial slippage of the femoral epiphysis. Positive Klein's sign with a line drawn through the lateral aspect of the femoral neck does not bisect the femoral epiphysis.

Metaphyseal oedema with low T1 and high PDFS / STIR signal. This appears as metaphyseal focal sclerosis "metaphyseal blanch sign" on plain x-ray. Mild joint effusion; indicative of mild synovitis.

 Incidentally noted is small bilateral inguinal lymphadenopathy. 

Modality: Annotated image

Klein's line (or line of Klein) is drawn along the lateral aspect of the neck of the femur.  The line should normally intersect the lateral part of the superior femoral epiphysis. Alignment of Klein's line  is disturbed with slip - the epiphysis is malaligned with no intersection of the capital femoral epiphysis.

Case Discussion

Slipped capital femoral epiphysis (SCFE), also known as slipped upper femoral epiphysis (SUFE), is the result of a Salter-Harris type I physeal fracture. SCFE occurs more common in obese males and occurs in early adolescence. Obesity and lack of normal anteversion as well as hormonal factors such as growth hormone deficiency, hypothyroidism and decreased testosterone are predisposing factors, in which the slip is often bilateral. 

Contralateral slips usually occur within two or three years of the primary slip. Secondary osteoarthritis of the hip and avascular necrosis of the femoral head are possible complications. The treatment of choice is by pinning with immediate internal fixation in situ using a single cannulated screw. 

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Case Information

rID: 23874
Case created: 15th Jul 2013
Last edited: 17th Dec 2015
Inclusion in quiz mode: Included

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