Search

The purpose of the study was to investigate the correlation of two different alpha angle (a-angle) measurements (“anatomical method and “three-point method”) with the anterior offset ratio (AOR), femoral head ratio (FHR), and lateral femoral head ratio (LFHR) in patients with slipped capital femoral epiphysis (SCFE). We included 39 hips of 26 patients. The a-angles were measured on the frog-leg lateral view (Lat) and anteroposterior (Ap) view, FHR was measured on the Ap view, and LFHR and AOR were measured on the Lat view. A t test was performed to analyze the means of the alpha angles measured using the three-point method and the anatomical method, and also, a correlation was conducted to assess the association of the a-angles among the FHR, LFHR, and AOR. The mean a-angles in the Ap plane in the three-point method and anatomical method were 76° ± 15° and 64° ± 10° respectively (p

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in older children and adolescents, classically with medial and posterior slippage of the proximal femoral epiphysis. However, valgus SCFE is a very rare entity, where the proximal femoral epiphysis slips laterally and posteriorly. To our knowledge, valgus SCFE with magnetic resonance imaging (MRI) features of contralateral pre-slip has not yet been reported. We present a case of a 9 year old girl with symptomatic valgus SCFE on the left and asymptomatic contralateral pre-slip on the right with concurrent radiographic, sonographic, and MRI findings. Such findings include bilateral coxa valga, radiographic irregularity of the left proximal femoral physis, bilateral hip effusions, abnormal MRI signal and enhancement about both proximal femoral physes, and minimal posterolateral slippage of the left proximal femoral epiphysis. We highlight these pertinent imaging findings and review the importance of accurately diagnosing this rare entity for appropriate surgical management.

We report the case of a 23-year-old man diagnosed with adult-onset idiopathic chondrolysis of the hip. Chondrolysis of the hip is a disorder most frequently seen in children who have suffered with slipped capital femoral epiphyses. Idiopathic chondrolysis of the hip is extremely rare and to our knowledge, its onset has never been documented in adults aged over 20. With reference to the available medical literature, we summarise the current clinical management of this unusual but important cause of young adult hip pain.

Slipped capital femoral epiphysis (SCFE) is a hip disorder where the femoral head slips relative to the neck at the physis. Appropriate treatment of SCFE depends on the severity of the slip, commonly categorised using the Southwick (SW) angle. The SW angle is measured in the frog-lateral leg position, which can be painful and potentially unattainable for patients. The purpose of this study is to determine how errors in frog-lateral radiograph positioning affect measured SW angles and slip classifications.Models of SCFE hips were produced from one CT scan of a normal hip; 360 deformities were created. SW angles were measured from a simulated frog-lateral position. Femoral lateral head-neck angles (LHNA; equivalent to SW in incorrect frog-lateral plane) were measured over a range of 837 incorrect frog-lateral leg positions with positioning errors in flexion and/or internal/external rotation.Seventy-six per cent of all imaging position-deformity combinations had error in the reported angle (1° difference between LHNA and SW). Of those, 70% had5°, 24% had 5° to 10°, and 6% had10° of error from the actual SW angle. Three per cent of LHNAs that had10° error resulted from10° of positioning error.If the patient is limited in flexion or external rotation, more diagnostic testing should be considered if error in the reported slip measurement would affect treatment decisions or if accurate severity classification is needed for research. Small positioning errors in moderate and severe slips can cause a 10° LHNA error; additional three-dimensional imaging should be considered.

Prophylactic fixation of the contralateral hip in slipped capital femoral epiphysis (SCFE) is controversial, and no reliable method has been established to predict subsequent contralateral slip. The main purpose of this study was to evaluate if magnetic resonance imaging (MRI) performed at primary diagnosis could predict future contralateral slip. Twenty-two patients with unilateral SCFE were included, all had MRI of both hips taken before operative fixation. Six different parameters were measured on the MRI: the MRI slip angle, the greatest focal widening of the physis, the global widening of the physis measured at three locations (the midpoint of the physis and 1 cm lateral and medial to the midpoint), periphyseal (epiphyseal and metaphyseal) bone marrow edema, the presence of pathological joint effusion, and the amount of joint effusion measured from the lateral edge of the greater trochanter. Mean follow-up was 33 months (range, 16–63 months). Six patients were treated for contralateral slip during the follow-up time and a comparison of the MRI parameters of the contralateral hip in these six patients and in the 16 patients that remained unilateral was done to see if subsequent contralateral slip was possible to predict at primary diagnosis. All MRI parameters were significantly altered in hips with established SCFE compared with the contralateral hips. However, none of the MRI parameters showed any significant difference between patients who had a subsequent contralateral slip and those that remained unilateral. MRI taken at primary diagnosis could not predict future contralateral slip.

Objective. To define and compare early lesions associated with slipped capital femoral epiphysis (SCFE) on magnetic resonance imaging (MRI), computed tomography (CT) and radiography. Design and patients. Thirteen patients with 15 symptomatic hips due to SCFE underwent radiography and MRI; CT was performed in 12 patients. SCFE was graded on radiographs, head/neck angles and qualitative changes were evaluated on CT, and morphologic/signal abnormalities were determined on MRI. Results. Physeal widening, apparent on T1-weighted MRI, was evident in every case of SCFE, including one presumed “pre-slip.” T2-weighted images demonstrated synovitis and marrow edema but obscured physeal abnormalities. CT head/neck angles ranged from 4–57° for symptomatic to 0–14° for asymptomatic hips. Physeal and metaphyseal changes were variably identified on both radiographs and CT in all cases of SCFE, but not in the pre-slip. Conclusion. MRI clearly delineates physeal changes of both pre-slip and SCFE, and demonstrates very early changes at a time when radiographs and CT may appear normal.

The conventional reference frame for the femur has limited relevance for the planning of hip surgery as the femoral neck axis, a crucial reference for surgeons, has to be independently derived. The purpose of this study is to develop and validate a reliable frame of reference for the proximal femur that can be applied in clinical settings. Ten three-dimensional models of femurs were obtained. An iterative method was developed to find the femoral neck axis (X-axis). A second axis was also created from the lesser trochanter to the piriformis fossa (LTPF). The origin was defined as the femoral head centre. The cross product of the neck and LTPF axes provided the Z-axis and the third axis (Y-axis) was perpendicular to the other two. Intra-/inter-investigator reliability was assessed on the ten femur models; ten times by one investigator and twice by three investigators respectively. The results were then compared with the conventional reference frame using landmarks on the distal femur. The femoral neck and LTPF axes had mean intra-/inter-investigator angle differences of 0.5° (SD 0.4°) and 0.7° (SD 0.5°), and 0.8° (SD 0.5°) and 0.9° (SD 0.6°) respectively while the variations of the X-, Y- and Z- axes were SD 0.6°, 0.7° and 0.5°. A reliable method of obtaining the three-dimensional proximal femoral frame was developed, using the femoral neck axis, with greater relevance to clinical settings, preoperative planning and accurate assessment of procedures post-operatively.

To demonstrate the clinical use of digital tomosynthesis in the depiction of labral and chondral pathology in the setting of post-operative CAM-type impingement of the hip following intra-articular administration of dilute iodinated contrast. We present images from a 46 year-old African American female with suspected CAM-type femoroacetabular impingement (FAI) following percutaneous pinning of the right hip for slipped capital femoral epiphysis (SCFE). A partial tear of the labrum and clinically significant acetabular chondral abnormalities were demonstrated with the use of digital tomosynthesis with superb anatomic detail. Digital tomosynthesis can be of great clinical utility and can depict pathology in superb anatomic detail, particularly in situations in which MRI is not available as well as under circumstances in which artifact due to orthopedic hardware is of concern as shown in this case.

The exact pathomechanism of slipped upper femoral epiphysis (SUFE) remains elusive. This paper suggests a generalised abnormality of the development or maturation of cartilage as a possible cause. It is proposed that SUFE is part of a generalised abnormality of the cartilage formation or maturation resulting in abnormal measurements of cartilaginous joint structures. Radiographs of SUFE patients were assessed for the width of the unaffected hip joint and the symphysis pubis. Comparison with previously published normal values was made. Fifty-one patients were assessed, 35 male, 16 female. The average age was 12 years and 11 months combined for both sexes, 13 years 8 months for boys, 11 years 4 months for girls. Width of the symphysis pubis was assessed on 46 datasets, and comparison with normal values was performed using the Wilcoxon paired rank test. Statistical significance was set as p

We describe the morphologic and signal changes detected about the proximal femoral growth plate in two patients with hip pain preceding the progression to slipped capital femoral epiphysis using magnetic resonance imaging.

We report on a 13-year-old boy who had a slipped capital femoral epiphysis and was found to have type II benign autosomal dominant osteopetrosis. This association has not previously been reported.

The etiology of slipped capital femoral epiphysis is still unknown. Traumatic, endocrine, toxic, and mechanical causes have all been hypothesized. It is well documented that the highest incidence occurs during the adolescent growth spurt, suggesting the role of an endocrine abnormality. We report a case that supports this hypothesis.

Slipped capital femoral epiphysis (SCFE) is an uncommon skeletal disorder of adolescence often overlooked because of its nonspecific clinical presentation. Anteroposterior radiography may fail to demonstrate a minimal slip even when clinical examination raises suspicion of the disease. On the other hand, prompt diagnosis is essential to obtain better therapeutic results. In our patient population joint effusion, which often accompanies SCFE, was readily recognized and quantified by ultrasonography (US). US also permitted recognition of the initial SCFE and assessment of the degree of slip by measuring the height of the physeal step. As to metaphyseal remodeling, plain radiography seems to be more informative than US; however, US has a role in the follow-up of SCFE because of the risk of slippage in the contralateral hip. This work suggests that US is useful as a primary imaging tool in the evaluation of subjects with limp or hip or knee pain to rule out SCFE.

Sixty-five patients with slipped capital femoral epiphysis were studied retrospectively for the development of aseptic necrosis. Seven (11%) patients developed segmental or total aseptic necrosis of the capital femoral epiphysis. Radiographically the changes of aseptic necrosis were detectable as early as four months. The cause for the aseptic necrosis is thought to be due to interruption of the blood supply to the capital femoral epiphysis at the time of slippage or during surgical manipulation.

Slipped proximal humeral epiphyses as a sequela of radiotherapy were identified in two children treated for Ewing's sarcoma in whom the shoulder was included in the field of treatment. The radiation doses were slightly greater than those in children developing slipped capital femoral epiphyses following radiotherapy. The lesser stress about the shoulder compared to the hip is believed to be the reason this is an infrequent complication of radiotherapy.

Pseudohypoparathyroidism (pseudo HPT) is the prototype of a group of diseases with end organ unresponsiveness to parathyroid hormone (PTH). Patients with the classic form of this disease have both renal and osseous resistance to PTH. We describe a rare variant of pseudo HPT with classic renal unresponsiveness to PTH but normal skeletal responsiveness to this hormone. The latter patients develop mentabolic bone disease in response to depressed calcium and elevated PTH levels. Skeletal abnormalities are histologically and radiologically indistinguishable from renal osteodystrophy and these patients frequently present in childhood with symptoms relating to slipped capital femoral epiphyses. The latter radiologic findings, in the face of normal renal function or the classic somatic features of the syndrome, are highly suggestive of pseudo HPT with normal skeletal responsiveness to PTH.