Slipped capital femoral epiphysis: Still an emergency

Journal of Pediatric Orthopaedics (Impact Factor: 1.47). 7(3):334-7.
Source: PubMed


Two case histories are presented in which acute progression of slipped capital femoral epiphysis occurred after a radiographic diagnosis of chronic slipped capital femoral epiphysis had been made. The importance of recognizing the potential for acute progression of a slipped epiphysis and the need for prompt orthopedic intervention are emphasized.

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    ABSTRACT: Slipped capital femoral epiphysis (SCFE) is a fairly common condition affecting older children and adolescents, and has the potential for long-term, crippling sequelae. Early recognition is the single most important controllable factor, but the diagnosis is often missed or delayed, resulting in progression of the slip. A SCFE should be suspected and promptly evaluated in any older child or adolescent presenting with a limp or complaints of hip, groin, thigh, or knee pain, especially if the patient is overweight. The diagnosis is usually made by anteroposterior and frog-leg lateral radiographs of the hips. Common errors at initial presentation include: not obtaining hip radiographs (due to either no hip pain or the lack of an impressive history and physical findings); misreading hip radiographs (the findings can be subtle); and lack of timely referral. Early involvement of and treatment by an orthopedic surgeon can greatly reduce the potential complications. We present three cases of SCFE that highlight common errors made at initial presentation, and a discussion that includes the differential diagnosis of an older child or adolescent with a painful limp.
    No preview · Article · Mar 1995 · Journal of Emergency Medicine
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    ABSTRACT: We have retrospectively reviewed 53 cases (62 hips) with a diagnosis of slipped capital wedge epiphysis. After admission to our Hospital, a skin longitudinal traction was applied for 2 weeks, All patients were treated afterward with pinning in situ without manipulation in the operating room. Group A (31 hips) consisted of patients treated with smooth K wires and group B (31 hips) of patients treated with cannulated screws. We found a high incidence of pin penetration in group A (27 hips), whereas there was just one case in group B. Physical closure was considered when 75% of proximal growth plate disappeared in the frog lateral view and both groups showed similar values (7 months). Chondrolysis was observed in just three cases in group A, and one case had an avascular necrosis. Few complications were observed compared with the high rate of pin penetration, and we suggest that preoperative traction may be a relevant factor contributing to the low incidence of avascular necrosis (1.6%).
    No preview · Article · Feb 1998 · Journal of Pediatric Orthopaedics B
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    ABSTRACT: Slipped capital femoral epiphysis (SCFE), though a relatively common disorder, is frequently missed on initial presentation. Symptoms can be vague, the physical examination unrevealing, and radiographic abnormalities subtle. Prompt diagnosis of SCFE is important, however, to improve clinical outcome. The emergency physician needs to remain vigilant for this diagnosis to avoid this orthopedic pitfall. This article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency physician in the treatment of SCFE.
    No preview · Article · Oct 2002 · American Journal of Emergency Medicine
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