Items in AFP with MESH term: Epiphyses, Slipped

Slipped Capital Femoral Epiphysis: Diagnosis and Management - Article

ABSTRACT: Slipped capital femoral epiphysis is the most common hip disorder in adolescents, and it has a prevalence of 10.8 cases per 100,000 children. It usually occurs in children eight to 15 years of age, and it is one of the most commonly missed diagnoses in children. Slipped capital femoral epiphysis is classified as stable or unstable based on the stability of the physis. The condition is associated with obesity and growth surges, and it is occasionally associated with endocrine disorders such as hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism. Patients usually present with limping and poorly localized pain in the hip, groin, thigh, or knee. Diagnosis is confirmed by bilateral hip radiography, which needs to include anteroposterior and frog-leg lateral views in patients with stable slipped capital femoral epiphysis, and anteroposterior and cross-table lateral views in patients with the unstable form. The goals of treatment are to prevent slip progression and avoid complications such as avascular necrosis and chondrolysis. Stable slipped capital femoral epiphysis is usually treated using in situ screw fixation. Treatment of unstable slipped capital femoral epiphysis usually involves in situ fixation, but there is controversy about the timing of surgery, value of reduction, and whether traction should be used.


Commonly Missed Orthopedic Problems - Article

ABSTRACT: When not diagnosed early and managed appropriately, common musculoskeletal injuries may result in long-term disabling conditions. Anterior cruciate ligament tears are some of the most common knee ligament injuries. Slipped capital femoral epiphysis may present with little or no hip pain, and subtle or absent physical and radiographic findings. Femoral neck stress fractures, if left untreated, may result in avascular necrosis, refractures and pseudoarthrosis. A delay in diagnosis of scaphoid fractures may cause early wrist arthrosis if nonunion results. Ulnar collateral ligament tears are a frequently overlooked injury in skiers. The diagnosis of Achilles tendon rupture is missed as often as 25 percent of the time. Posterior tibial tendon tears may result in fixed bony planus if diagnosis is delayed, necessitating hindfoot fusion rather than simple soft tissue repair. Family physicians should be familiar with the initial assessment of these conditions and, when appropriate, refer patients promptly to an orthopedic surgeon.


Slipped Capital Femoral Epiphysis - Article

ABSTRACT: Slipped capital femoral epiphysis occurs during the adolescent growth spurt and is most frequent in obese children. Up to 40 percent of cases are bilateral. Recent classification methods emphasize epiphyseal stability rather than symptom duration. Most cases of slipped capital femoral epiphyses are stable and have a good prognosis if diagnosed early. Unstable slipped capital femoral epiphysis has a much poorer prognosis because of the high risk of avascular necrosis. Early radiographic clues are the metaphyseal blanch sign and Klein's line. Once diagnosed, treatment should begin immediately. The most widely accepted treatment for a stable slipped capital femoral epiphysis is in situ fixation with a single central screw. The treatment for an unstable slipped capital femoral epiphysis is much more controversial. Corrective osteotomy is usually reserved for treatment of severe deformities after the patient has stopped growing.



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