Imaging modalities in patients with slipped capital femoral epiphysis

Hesper, Tobias; Zilkens, Christoph; Bittersohl, Bernd; Krauspe, Rüdiger

doi:10.1302/1863-2548-11-160276

Cited by 39 publications

(38 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The froglateral pelvis projection is the examination of choice for establishing the diagnosis of SCFE. Unfortunately, this projection is either ignored or not ordered on patient admission, in an attempt to spare the patient from additional radiation exposure [1,42]. Repeated admissions and examinations of the limping patient will usually lead to diagnosis and surgery, at the expense of a slip of higher severity and worse long-term results after treatment [1,17,33,38,40].…”

Section: Delayed or Missed Diagnosis Of Scfementioning

confidence: 99%

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Samelis

Papagrigorakis

Konstantinou

et al. 2020

Cureus

View full text Add to dashboard Cite

Slipped capital femoral epiphysis (SCFE) is a frequent cause of nontraumatic painful hip of the adolescence. It is the result of the separation of the proximal femoral growth cartilage at the level of the hypertrophic cell zone. The femoral neck metaphysis rotates externally and migrates proximally relative to the femoral head epiphysis, which is stably seated in the acetabulum; early diagnosis and in situ stabilization grants the best long term results. Numerous factors affect treatment outcomes. Not all implants have the same effect on the slipped physis. Application of the traditionally used implants, such as non-threaded pins and cannulated screws, is questioned. Modern implants are available, which stabilize the slip without accelerating physis fusion. This allows femoral head and neck growth and remodeling to limit the post-slip sequellae on hip anatomy and function. Femoroacetabular impingement (FAI) complicates almost all slips. It causes progressive labral and articular cartilage damage and leads to early hip osteoarthritis and total hip replacement, approximately ten years earlier compared to the general population. Avascular necrosis of the femoral head is a dramatic complication, seen almost exclusively in unstable slips. It develops within months after the slip and leads to immediate articular joint degeneration and the need for total hip replacement. Another serious complication of SCFE is chondrolysis, which is a rapid progressive articular cartilage degeneration leading to a narrow joint space and restriction of hip motion. Implant-related complications, such as migration and loosening, may lead to the progression of the slip. Though bilateral disease is quite frequent, there is no consensus about the need for preventive surgery on the healthy contralateral hip. Diagnosis of SCFE is frequently missed or delayed, leading to slips of higher severity. Silent slippage of the capital femoral epiphysis is highly suspected as an underlying cause of cam-type FAI and earlyonset hip osteoarthritis. There is controversy, whether asymptomatic implants should be removed. Novel surgical techniques, such as the modified Dunn procedure and hip arthroscopy, seem to be effective modalities for the prevention of FAI in SCFE.

show abstract

Section: Delayed or Missed Diagnosis Of Scfementioning

confidence: 99%

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Samelis

Papagrigorakis

Konstantinou

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…If not addressed promptly, it may lead to complications such as avascular necrosis of the femoral head, chondrolysis, and early osteoarthritis. 45 Anteroposterior (AP) and frog-lateral radiographs of the pelvis should be obtained. Typical radiographic signs include physeal widening, relative decrease in epiphyseal height on the AP view, and the "metaphyseal blanch sign" that implies an increase in radiographic density at the upper medial femoral neck secondary to the posteriorly projecting femoral head 45 (►Fig.…”

Section: Slipped Capital Femoral Epiphysismentioning

confidence: 99%

“…The posterior sloping angle, also drawn on the frog-leg lateral view (between a line connecting the anterior and posterior aspects of the femoral epiphysis and a line drawn perpendicular to the femoral shaft), effectively predicts contralateral SCFE, and prophylactic contralateral pinning is advocated when thresholds are met. 45 Of note, early SCFE can be imminent (preslip) or incipient (beginning of slippage) 45 (►Fig. 11).…”

Section: Slipped Capital Femoral Epiphysismentioning

confidence: 99%

“…Ultrasound can show a step-off between epiphysis and metaphysis, and hip joint fluid with capsular distension may be seen in cases of unstable SCFE. 45 MRI evaluation should be limited to subtle cases of imminent SCFE only, in which plain radiographs are not definitive. MRI may reveal widening and edema of the physis, periphyseal marrow edema and joint effusion, and can also depict femoral head vascularity.…”

Section: Slipped Capital Femoral Epiphysismentioning

confidence: 99%

“…CT has very limited utility and should only be considered in severe cases to depict femoral and acetabular morphology. 45 Treatment of SCFE is with open reduction and screw fixation across the physis (►Fig. 12c).…”

Section: Slipped Capital Femoral Epiphysismentioning

confidence: 99%

See 2 more Smart Citations

The Acutely Limping Preschool and School-Age Child: An Imaging Perspective

Chaturvedi

Cain

Rupasov

2018

Semin Musculoskelet Radiol

View full text Add to dashboard Cite

Acute limp in a child presents a diagnostic conundrum and can result from a variety of causes. The underlying etiology is often referable to the hip, but the spine, abdomen, pelvis, or knee can be alternatively implicated. An adequate clinical history and satisfactory physical examination are often difficult in younger children. Consequently, there is disproportionate reliance on imaging to arrive at the correct diagnosis. The potential for rapid clinical deterioration and long-term sequelae is a risk with some of the conditions presenting with acute hip (septic hip, osteomyelitis). This review article describes the imaging appearance of common etiologies for acute limp in the ambulatory preschool (1-5 years) and school-age child (5-12 years). The ultimate goal is to familiarize the interpreting radiologist with the imaging appearance of specific clinical entities that lead to acute limp while providing a readily accessible resource on how to image the patient most appropriately and judiciously.

show abstract

The morphogenesis of porcine femoral head mammillary processes: A structural mechanism of biomechanical stability

Perrone

Williams

2021

The Anatomical Record

View full text Add to dashboard Cite

The capital femoral physis is a growth plate located between the head of the femur and femoral neck, which forms a temporary joint where growth plate cartilage is converted to bone by endochondral ossification. The bone‐cartilage‐bone interface develops a unique radial pattern of interdigitating mammillary processes that interlock the femoral head with the metaphysis, increasing biomechanical stability. The arrangement of these mammillary processes may not be a random occurrence and likely serves to provide mechanical mechanisms to enhance biomechanical stability. In this study, we provide a qualitative and quantitative analysis of porcine femoral head mammillary processes and focus on the analysis of six key points of development: the epiphyseal tubercle, epiphyseal cupping, growth plate slope angles, expansion of the epiphyseal subchondral bone plate, epiphyseal elongation, and the emergence of smaller, radially arranged mammillary processes. We introduce a metric of surface roughness analysis to quantify mammillary processes and apply it to analyze the development of the observed radial pattern of peripheral mammillary processes from birth to adolescence. We hypothesized that these processes develop to form a radial pattern with some degree of periodicity beginning relatively early in development of the joint and increase in prominence with age and weight of the animal. These findings may have important implications in the early diagnosis and treatment of the hip disorder slipped capital femoral epiphysis (SCFE). Underdevelopment of femoral head mammillary processes may reduce joint stability and could be a risk factor in SCFE.

show abstract

Imaging modalities in patients with slipped capital femoral epiphysis

Cited by 39 publications

References 76 publications

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

The Acutely Limping Preschool and School-Age Child: An Imaging Perspective

The morphogenesis of porcine femoral head mammillary processes: A structural mechanism of biomechanical stability

Contact Info

Product

Resources

About