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An eleven-year-old girl.

Our appreciation is extended to Dr. Jeremy Cardinal,
Indiana University Department of Radiology,
for contributing this case.

History:  An eleven-year-old girl.


Review the image below. Which choice is most likely the chief complaint?

Bilateral hip pain.Right hip pain.Left hip pain.Sacral pain.Suprapubic pain.Image
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An eleven-year-old girl.


Right hip pain for 2 weeks after playing tennis.

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Can you select the actual diagnosis?

Osteomyelitis.Avascular necrosis.Legg-Calve-Perthes disease.Slipped capital femoral epiphysis.Juvenile idiopathic arthritis.
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An eleven-year-old girl.

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Findings:  The plain radiographs demonstrate widening and irregularity of the right capital femoral physis. The MR images demonstrate edema and enhancement adjacent to the capital femoral physis in the metaphysis and epiphysis.


Differential diagnosis:

  • Slipped capital femoral epiphysis (SCFE)
  • Femoral head avascular necrosis
  • Osteomyelitis
Diagnosis:  Slipped capital femoral epiphysis (SCFE)
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An eleven-year-old girl.


Key points:
 

  • SCFE is a Salter-Harris 1 fracture of the capital femoral physis, which occurs secondary to repetitive stress from weight bearing.
  • Most common in boys age 10-17
  • Obesity is a significant risk factor.
  • Contralateral SCFE is common (18-100%) and usually occurs within 24 months of the first occurrence.
  • Evaluation begins with plain radiographs including pelvis AP and bilateral hips frog-lateral views.
  • Klein's line, drawn along the superior aspect of the femoral neck, should intersect the epiphysis. If it does not, then SCFE is likely.
  • Widening of the physis may occur before the slip is recognizable (as in our case).
  • Treatment is immediate internal fixation in-situ (without attempted reduction) using a single cannulated screw.
  • Delay in treatment increases the risk of avascular necrosis of the femoral head.

References: 

  1. Corning, Benton MD. "Slipped Capital Femoral Epiphysis." StatDx. https://my.statdx.com/STATdxMain.jsp?rc=false#dxContent;slipped_capital_femoral_epiphysis.
  2. Walter, Kevin. MD. "Slipped Capital Femoral Epiphysis" eMedicine (Aug 11, 2011) http://emedicine.medscape.com/article/91596-overview.
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An eleven-year-old girl.


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