Slipped capital femoral epiphysis
Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode in Paediatric Orthopaedics, 2016
Slipped capital femoral epiphysis (SCFE) is an anterior, superior and external rotational displacement of the proximal femoral metaphysis relative to the fixed epiphysis which occurs through the physis during the prepubescent and adolescent growth spurt. The average age of presentation in boys is 13 years and in girls 12 years. If untreated, the slip cans progress and a small proportion of unstable SCFEs can progress despite seemingly adequate treatment. Slipped capital femoral epiphysis is felt to be a common cause of degenerative hip disease in adult life. As the severity of the SCFE increases so does the incidence of degenerative hip disease later in life; thus diagnosis at a lesser degree of SCFE is desirable. In situ fixation involves placement of a single cannulated screw in the centre of the epiphysis in both anteroposterior and lateral views, and gives excellent results in stopping SCFE progression with minimal risk of chondrolysis.
Advances in slipped upper femoral epiphysis
K. Mohan Iyer in Hip Joint in Adults: Advances and Developments, 2018
Slipped upper femoral epiphysis (SUFE), also termed slipped capital femoral epiphysis, is a common paediatric hip disorder involving failure of the proximal femoral physis with subsequent displacement. It is the most common adolescent hip disorder, occurring in up to 10 per 100,000 people. The cause of a SUFE is unclear, but it is suspected that an abnormal load exerted on a normal proximal femoral physis or a normal load exerted on an abnormal physis may be the reason for injury. A SUFE occurring before 10 years of age or in a child below the 50th percentile should raise concern of an underlying endocrine disorder. The displacement in a SUFE may be slow to progress, with minimal symptoms, but alternatively may slip further, increasing pain and affecting function. For a stable SUFE, in situ pinning is the treatment of choice to prevent further slip. A patient with an unstable SUFE cannot weight-bear according to the Loder classification.
Bones and joints Case 58: A girl with a limp
Ronny Cheung, Aubrey Cunnington, Simon Drysdale, Joseph Raine, Joanna Walker in 100 Cases in Paediatrics, 2017
The diagnosis is a slipped upper femoral epiphysis (SUFE). SUFE is commoner in boys and in obese individuals. Pain can be felt in the groin, hip or thigh or there may be referred pain in the knee. Classically, the affected hip is flexed and the leg is externally rotated. A small slip may be missed on the anteroposterior view, therefore a lateral or frog leg view of the hip is also necessary. The lateral X-ray shows displacement of the proximal femoral epiphysis relative to the femoral neck. Approximately 25 per cent of patients will also have a contralateral slip and the other hip must therefore be carefully assessed.
Evaluation of distal femoral epiphysis and proximal tibial epiphysis ossification using the Vieth method in living individuals: applicability in the estimation of forensic age
Published in Australian Journal of Forensic Sciences, 2021
Murat Serdar Gurses, Hasan Baki Altinsoy
ABSTRACT In this study, ossification stages of distal femoral epiphysis and proximal tibial epiphysis were retrospectively evaluated with a 1.5-T magnetic resonance imaging (MRI) scanner according to the newly developed five-stage Vieth method. A total of 367 male and 231 female patients aged 12–30 years were scanned between January 2012 and July 2019. A 1.5-T MRI scanner was used to obtain a T1-weighted turbo spin-echo (TSE) sequence and a fat-suppressed proton density-weighted TSE image. The kappa statistics were good level of agreement for inter- and intra-observer evaluations of the ossification stages for knee. Comparison of male and female data revealed significant between-sex differences in the ages when the stages 3, 4 and 5 ossifications of the distal femoral epiphysis and the stages 4 and 5 ossifications of the proximal tibial epiphysis were first detected. In the proximal tibial epiphysis, stage 6 was observed at age 18 years for males and at age 17 years for females. In the distal femoral epiphysis, stage 6 was initially observed at age 20 years for both sexes. Thus, stage 6 ossification, which is determined through 1.5-T MRI of the knee joint, allows for the determination of the completion of the 18th year of life in either sex.
Osteomyelitis of the proximal radial epiphysis: A case report
Published in Acta Orthopaedica Scandinavica, 1990
A case of osteomyelitis of the proximal radial epiphysis in a 6-year-old boy is presented. The effect on the cartilaginous tissues and the potential for growth of the epiphysis must be considered.
Epiphyseal bone-marrow abnormalities and restitution in legg-calvé-perthes disease
Published in Acta Radiologica, 1997
Peter Hochbergs, G. Eckervall, H. Wingstrand, N. Egund, K. Jonsson
Purpose: By means of MR imaging, to determine signal abnormalities in the femoral epiphysis; to determine their location, extent and restitution over time; and to correlate these findings to the Catterall radiological classification. Material and Methods: A total of 247 MR images in 86 patients (101 hips) with Legg-CalvC-Perthes disease were examined. The MR images were taken in the coronal plane, and the images through the center of the femoral head were used for this study. Results: T1-weighted images proved as good as T2-weighted images for the MR evaluation of the extent of the necrosis. In almost every case, the central-cranial part of the epiphysis showed a low initial signal. In Catterall group I, the medial part was never involved. In Catterall III and IV, almost the entire epiphysis showed signal changes. In the period 3–6 years after diagnosis, we still found signal changes in the epiphysis in some hips but there was no correlation with the Catterall classification. After 6 years, the epiphysis showed normal signal intensity in MR imaging. In T1-weighted images, Gd-enhancement occurred in the peripheral regions in the early stages of the disease. The central part of the epiphysis became more enhanced over time and peaked in the period 1–3 years after diagnosis. Conclusion: MR is a valuable modality for monitoring changes in the femoral epiphysis. We propose a new classification of the extent and pattern of epiphyseal bone-marrow abnormalities based on the 4 zones most commonly observed in MR imaging.