Gonad protection is usually used in pelvic x-rays of children. This is followed by the acute slip which is posteromedial. In a chronic slip, the physis becomes sclerotic and the metaphysis widens coxa magna. It is therefore is more easily seen on the frog-leg lateral view rather than the AP hip view. Because the epiphysis moves posteriorly, it appears smaller because of projectional factors.
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Gonad protection is usually used in pelvic x-rays of children. This is followed by the acute slip which is posteromedial. In a chronic slip, the physis becomes sclerotic and the metaphysis widens coxa magna. It is therefore is more easily seen on the frog-leg lateral view rather than the AP hip view. Because the epiphysis moves posteriorly, it appears smaller because of projectional factors. On the AP, a line drawn up the lateral edge of the femoral neck line of Klein fails to intersect the epiphysis during the acute phase Trethowan sign.
The metaphysis is displaced laterally and therefore may not overlap posterior lip of the acetabulum as it should normally loss of triangular sign of Capener 5. The metaphyseal blanch sign , a sign seen on AP views, involves increases in the density of the proximal metaphysis.
It represents the superposition of the femoral neck and the posteriorly displaced capital epiphysis. Alignment of the epiphysis with respect to the femoral metaphysis can be used to grade the degree of slippage: see SUFE grading.
Ultrasound Ultrasound may be performed in the assessment of hip pain. However, it should not be used as a replacement for a pelvic radiograph. Findings are nonspecific and may include hip joint effusion.
In some cases, malalignment of the femoral epiphysis and metaphysis may be seen. Multi-plane reconstruction allows assessment of the relationship of the femoral head to the metaphysis in three planes. However, the dose required for the examination means that it should not be used unless absolutely necessary. MRI In the acute stage, marrow edema results in an increased signal on T2-weighted sequences, e.
Marrow edema is non-specific, and while it may indicate early bone changes in SUFE, there are numerous other causes, e. MRI can be used to examine the contralateral hip which is important because of the high incidence of bilateral slip.
STIR high signal in epiphysis and metaphysis joint effusion low signal in edematous regions metaphyseal displacement Treatment and prognosis Treatment of unstable slipped upper femoral epiphysis has progressively shifted exclusively towards surgical pinning.
Conservative management e. Treatment of the contralateral hip is more controversial. As such prophylactic pinning is recommended by some 3. If a significant deformity is present, then osteotomies and even joint replacement may be required. Ideally, however, the diagnosis is made early in which case the differential is that of a painful hip and includes:.
Epiphyseolysis capitis femoris
Often the range of motion in the hip is restricted in internal rotation , abduction , and flexion. Complications[ edit ] Failure to treat a SCFE may lead to: death of bone tissue in the femoral head avascular necrosis , degenerative hip disease hip osteoarthritis ,  gait abnormalities and chronic pain. SCFE is associated with a greater risk of arthritis of the hip joint later in life. A study in Scotland looked at the weight of , infants, and followed them up to see who got SCFE. In 65 percent of cases of SCFE, the person is over the 95th percentile for weight.
Slipped capital femoral epiphysis