SCFE

AP Radiograph of Pelvis in an skeletally maturing patient 

There is a mild slip of upper femoral epiphysis with a positive Trethrowan's sign shown up by drawing a Klein's line up the lateral border of femoral neck and noting it doesn't intersect epiphysis.

How to classify this condition ?

    Lodler's Classification 

    Stable and Unstable based upon patient's ability to bear weight secondary to pain and is important for predicting risk of AVN.

   Other classifications 

    Mild (<33 % ) , Moderate (33-50 %) and severe (>50 % ) , useful to decide which are pinnable or not.

 

Management 

    Full history of patients and parents.
    Examine the child 

    Endocrinopathies

    Examination 

        hip that externally rotates and abducts with flexion     

    Investigations 

        X-ray Pelvis - AP, Lateral - affected hip

        Hormonal Assays ,RFT

    Management 

        Pinning slip in situ with a single cannulated screw. > 1 screw leads to AVN and Chondrolysis.

    Note - not to use force. 

     use triangulation technique and define appropriate location for skin incision

    thread of screw should be in centre of epiphysis through physis. 

    (Posteromedial slip requires anterior femoral neck entry point. )

     Minimum of two / three screw threads should pass into epiphysis depending on size of child and the         instrument used. 

     

What will be the management plan in opposite hip ?

    Prophylactic screw fixation in contralateral side.

    Options - treat all cases with contralateral fixation or only those at risks  

                    risks - underlying endocrinopathy, significant LLD, age < 10 years old.