SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)
| A | Coxa vara | |
| B |
Slipped capital femoral epiphysis |
|
| C |
Perthe’s disease |
|
| D |
Fracture acetabulum |
Diagnose the orthopaedic disorder shown in the photograph below ?
| A |
Coxa vara |
|
| B |
Slipped capital femoral epiphysis |
|
| C |
Perthe’s disease |
|
| D |
Fracture acetabulum |
Ans.B. The line marked in the picture above represents Trethowan’s line. The Trethowan sign is used to diagnose slipped capital femoral epiphysis.
Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and pre-teens who are still growing. For reasons that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction. This causes pain, stiffness, and instability in the affected hip. The condition usually develops gradually over time and is more common in boys than girls.
The cause of SCFE is not known. The condition is more likely to occur during a growth spurt and is more common in boys than girls.
Risk factors that make someone more likely to develop the condition include:
- Excessive weight or obesity—most patients are above the 95th percentile for weight
- Family history of SCFE
- An endocrine or metabolic disorder, such as hyperthyroidism—this is more likely to be a factor for patients who are older or younger than the typical age range for SCFE (10 to 16 years of age)
A patient with mild or stable SCFE will usually have intermittent pain in the groin, hip, knee and/or thigh for several weeks or months. This pain usually worsens with activity. The patient may walk or run with a limp after a period of activity.
In more severe or unstable SCFE, symptoms may include:
- Sudden onset of pain, often after a fall or injury
- Inability to walk or bear weight on the affected leg
- Outward turning (external rotation) of the affected leg
- The discrepancy in leg length—the affected leg may appear shorter than the opposite leg.
| A |
Shenton’s line. |
|
| B |
Trethowan’s line. |
|
| C |
Salter’s line. |
|
| D |
Von Rosen’s line. |
The line represented in the picture above represents Trethowan line.
Trethowan line – along the upper border of the femoral neck on hip x-ray, failure to enter the head indicates slipped upper femoral epiphysis.
In which condition,the following type of abnormality is seen?
| A |
Congenital Dislocation of Hip |
|
| B |
Coxa Valga |
|
| C |
Genu Valgum |
|
| D |
Slipped Capital Femoral Epiphysis |
Ans:D.)Slipped Capital Femoral Epiphysis.
Trethowan’s Sign is shown in the image.
SLIPPED CAPITAL FEMORAL EPIPHYSIS
- In this condition, the upper femoral epiphysis may get displaced at the growth plate, usually posteromedially, resulting in coxa vara.
CLINICAL FEATURES
• Age: It occurs at puberty (between 12-14 years).
• Sex: It is commoner in boys.
• There is a definite history of trauma in some cases.
• It is commoner in patients with endocrine abnormalities.
Presenting symptoms:
- Pain in the groin, often radiating to the thigh and the knee is the common presenting complaint.
- Limp occurs early and is more constant.
Examination:
- The leg is found to be externally rotated and 1-2 cm short.
- Limitation of hip movements is characteristic – there are limited abduction and internal rotation, with a corresponding increase in adduction and external rotation.
- When the hip is flexed, the knee goes towards the ipsilateral axilla. Muscle bulk may be reduced.
- Trendelenburg’s sign may be positive.
RADIOLOGICAL FEATURES
• On AP view: The growth plate is displaced towards the metaphyseal side. A line drawn along the superior surface of the neck remains superior to the head unlike in a normal hip where it passes bisecting the head –Trethowan’s sign
• On lateral view: The head is angulated on the neck. This can be detected early