Ultrasonography in slipped capital femoral epiphysis. Diagnosis and assessment of severity

Kallio, PE; LeQuesne, G. W.; Paterson, Dennis C.; Foster, BK; Jones, Jones

doi:10.1302/0301-620x.73b6.1955429

Cited by 53 publications

(20 citation statements)

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“…Our focused assessment during this examination was to determine the presence or absence of SCFE, and therefore in this case, the degree of posterior epiphyseal displacement was not measured. However, it should be noted that the degree of posterior epiphyseal displacement appears to correlate with the severity of the slip when compared to plain radiography [6]. The ability to compare findings to the contralateral side is of significant value to the operator, yet providers must remember that SCFE may occur bilaterally and that symptoms can be vague.…”

Section: Resultsmentioning

confidence: 99%

Point-of-care ultrasound diagnosis of SCFE

Stone

Barrett

2010

Crit Ultrasound J

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Introduction A 13-year-old boy presented to the emergency department with left knee pain after a fall. Initial radiographs were unremarkable, but the child returned to the emergency department 6 weeks later with persistent symptoms. Materials and methods A bedside sonogram of the left hip performed by the treating emergency physician demonstrated a widened epiphyseal plate and an associated effusion, consisted with a slipped capital femoral epiphysis (SCFE). Repeat radiographs confirmed the diagnosis. Conclusion The ultrasound features and test characteristics for the detection of SCFE are reviewed.Keywords Emergency ultrasound Á Critical ultrasound Á Slipped capital femoral epiphysis Á SCFE Case reportA 13-year-old male with no prior medical history presented to the emergency department with left knee pain after a mechanical fall from standing. Vital signs were normal and physical examination revealed diffuse tenderness to the left hip and knee. Radiographs of the left knee and pelvis ( Fig. 1) were interpreted as unremarkable, and the patient was placed in a knee immobilizer and discharged with orthopedic follow-up.Approximately 6 weeks later, the patient returned to the emergency room for left hip and knee pain for 14 days and the inability to bear weight. The patient reported having sustained an additional fall 2 weeks prior to this visit. The patient's temperature was 98.1 F, pulse 82/min, blood pressure 127/62 mmHg, respirations 16/min and room air oxygen saturation 100%. The patient was in mild distress due to pain, and the left knee and left hip were diffusely tender to palpation. There was limited active and passive range of motion of the hip, and an antalgic gait. Neurological and vascular exams were normal. Results and discussionGiven the patient's previous normal radiographs, the treating emergency physician performed a bedside ultrasound of the left hip using a 5-2 MHz curvilinear transducer (SonoSite MTurbo, Bothell WA) aligned parallel to the femoral neck. A joint effusion was identified and widening of the epiphyseal plate with displacement of the epiphysis from the metaphysis was noted ( Fig. 2; asterisk = growth plate, e = effusion) suggesting a slipped capital femoral epiphysis (

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Section: Resultsmentioning

confidence: 99%

Point-of-care ultrasound diagnosis of SCFE

Stone

Barrett

2010

Crit Ultrasound J

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“…Ultrasonography has been used for both diagnosing and staging SCFE [6,7]. Ultrasonography findings in slipped capital femoral epiphysis include a posterior displacement of the epiphysis with a physeal step, reduced distance between the anterior rim of the acetabulum and the metaphysis, joint effusion and remodeling of the metaphysis.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography findings in slipped capital femoral epiphysis include a posterior displacement of the epiphysis with a physeal step, reduced distance between the anterior rim of the acetabulum and the metaphysis, joint effusion and remodeling of the metaphysis. Severity of SCFE may be graded based on the anterior physeal slip (APS) measurement (Grade I – APS <7 mm; Grade II – APS 7–11 mm; Grade III– APS >11 mm) [6]. …”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography can detect minimal slips with a better sensitivity than radiography with avoidance of radiation exposure [6,7]. Although MRI appears to be the most sensitive modality for identifying slips early [8], ultrasound may be used as a cost-effective and radiation-free alternative before proceeding with further evaluation of suspected SCFE, especially considering the demographics of the affected population.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasonographic Diagnosis of Slipped Capital Femoral Epiphysis

2018

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SummaryBackgroundSlipped capital femoral epiphysis (SCFE), a fracture through the physis with resultant slip of the epiphysis, is the most common hip abnormality in adolescents and is a major cause of early osteoarthritis. Plain radiograph is the initial modality used to evaluate patients with painful hip joints. Ultrasonography and magnetic resonance imaging (MRI), which do not involve radiation exposure, have also been used. This case report supports the view that ultrasound can be used as an initial, cost-effective and radiation-free modality for the evaluation of suspected SCFE.Case ReportA 15-year-old male patient presented with pain in the right hip for 5 days, following a slip and fall accident while playing soccer. The patient was referred to the Department of Radio-diagnosis for ultrasound. A posterior displacement of the femoral head epiphysis with a physeal step was seen on the longitudinal section obtained over the right hip joint region. The anterior physeal step (APS) measured ~3.8 mm on the right side. The distance between the anterior rim of the acetabulum and the metaphysis measured ~20.4 mm on the affected right side and ~23.6 mm on the left side. A plain radiograph in frog leg position showed a widening of the right proximal physis below the right femoral head, with a medial and posterior slip of the right femoral head. A frontal radiograph of the pelvis taken six months before showed a widening of the proximal right femoral physis.ConclusionsAlthough MRI appears to be the most sensitive modality for identifying slips early, ultrasound may be used as a cost-effective and radiation-free alternative before proceeding with further evaluation of suspected SCFE, especially considering the demographics of the affected population.

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“…It can be used to detect early slips by demonstrating a joint effusion and a step between the femoral neck and epiphysis. 31 …”

Section: Ultrasound Scanmentioning

confidence: 99%