Slipped upper femoral epiphysis is more common in boys than girls and more common in Afro-Caribbeans than Caucasians. Obesity is a significant risk factor. During growth, there is a widening of the physeal plate which is particularly pronounced during a growth spurt. Also, the axis of the physis alters during growth and moves from being horizontal to being oblique. As the physis becomes more oblique, shear forces across the growth plate increase and result in an increased risk of fracture and resultant slippage. In all situations, especially when imaging children, the fewest number of radiographs, with the smallest exposed area is performed.
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Average 4. Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine. Just skip this one for now. He is found on imaging to have a severe slipped capital femoral epiphysis.
If his leg is not manipulated for imaging, in what abnormal position is his left hip most likely to appear on an anteroposterior pelvic radiograph? Review Topic Tested Concept. Radiographs taken preoperatively, 1 week and 8 months postoperatively are seen in Figures A through C. What complication has occurred? She is not dependent on crutches for ambulation. Physical examination reveals external rotation of the extremity with hip flexion. Her parents indicate that outside radiographs were interpreted to be normal.
What is next best step in management? He does not have a history of kidney disease. The initial radiograph is shown in Figure A. Which of the following zones of the growth plate Figures B-F, all the same magnification is most commonly involved in this condition? Preoperative radiographs are seen in Figure A, radiographs six months after in situ fixation are seen in Figure B. Which of the following is associated with the radiographic abnormality seen in Figure B? Which of the following figures accurately represents the method used to determine the radiographic severity of the epiphyseal slip and help guide treatment?
His pain has significantly worsened over the past week. He denies pain in the right leg. Radiographs are taken and shown in Figures A and B. The history and physical do not reveal any findings concerning for an endocrine disorder.
What is the preferred method of treatment? She has a past medical history of hypothyroidism. She undergoes in-situ screw fixation of her right hip with no intra-operative complications. Which of the following problems is most likely to occur in this scenario? She was recently diagnosed with hypothyroidism and started treatment 1 week ago. Examination reveals a mild abductor deficiency limp on the left side. She lacks 30 degrees internal rotation on the left hip compared with the right hip.
Management should consist of Review Topic Tested Concept. Open reduction and pinning with multiple cannulated screws in an inverted triangle configuration. Closed reduction and pinning with multiple cannulated screws in an inverted triangle configuration.
In situ percutaneous pinning with multiple cannulated screws in an inverted triangle configuration. Clinical examination and radiographs of the knee are normal. Additional evaluation should include Review Topic Tested Concept. Her radiograph is shown in Figure A. What is the most appropriate treatment? His radiographs are shown in Figures A and B. Forceful manipulation is not indicated because it is associated with an increased risk of complications. Associated with decreased femoral anteversion and decreased femoral neck-shaft angle.
He is now unable to place weight on the left lower extremity, even with the assistance of crutches. AP pelvis radiograph is shown in Figure A.
He is treated with surgical intervention and post-operative radiographs are shown in Figures B and C. What is the most common limb length and rotational profile found as a sequelae of this condition? She has 2 years of activity-related left hip pain and pain with prolonged sitting. On physical examination she has restricted hip flexion motion, an external rotation deformity, and obligatory external rotation upon hip flexion manuevering.
Radiographs are shown in Figures A and B. Which of the following osteotomies is MOST appropriate? Flexion, internal rotation, and valgus-producing proximal femoral osteotomy Imhauser osteotomy. Bernese periacetabular osteotomy with extension, external rotation, and valgus-producing femoral osteotomy. Valgus-producing intertrochanteric proximal femoral osteotomy Pauwel osteotomy.
Which of the following vessels gives the greatest blood supply to the femoral head? He has an antalgic gait and increased external rotation of his foot progression angle compared to the contralateral side. Knee radiographs, including stress views, are negative. What is the next step in management? Ashley Bassett. Chris Souder. Eric Shirley. Please rate topic.
Please vote below and help us build the most advanced adaptive learning platform in medicine The complexity of this topic is appropriate for? L2 - PGY3. L3 - PGY4. L4 - PGY5. L5 - Fellow. L6 - years in practice. L7 - years in practice. L8 - 10 years in practice. How important is this topic for board examinations? How important is this topic for clinical practice? No, Thanks Submit. Technique Guide. Rachel Goldstein. Paul Choi.
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Listen Now min. Team Orthobullets AF. Bilateral Genu valgum with bilateral slipped capital femoral epiphysis C Kanagaratnam Kandeepan. Please login to add comment.
Cancel Save. Loder Classification -- based on ability to bear weight. Provides prognostic information for complication of femoral head osteonecrosis. Temporal Classification -- based on duration of symptoms; rarely used; no prognostic information.
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Slipped Capital Femoral Epiphysis (SCFE)