Paediatric MSK

Question 2

A 14-year-old attends ED unable to weight-bear with no traumatic history. The clinical team suspect a slipped upper femoral epiphysis and an AP X-ray is performed. It is not clear whether there is a slip on the AP x-ray. What is the next best test to perform?

• CT hip
• Frog-leg lateral
• MRI pelvix
• No further imaging
• Turned lateral of the hip

Answer 2

Frog-leg lateral
If the clinical suspicion is of a slipped upper femoral epiphysis, confirming that radiologically is required. If the AP pelvis is normal, then a frog-leg lateral will often confirm the diagnosis. In some cases, it will also demonstrated bilateral disease that wasn’t suspected clinically.

In severe cases, CT can be used to determine screw placement and work out whether the slip needs to be reduced prior to fixation. MRI can be used to help prognosticate in severe cases too; post-contrast imaging can help determine the likelihood of future avascular necrosis.

Question 3

Regarding slipped capital femoral epiphysis - SCFE, all of the followings are true except :

• It is a Salter-Harris type 1 fracture
• 25% of cases are bilateral
• The primary direction of slippage is medial and anterior
• Normally, Klein’s line should intersect at least one sixth of the femoral epiphysis on an AP view
• The aim of surgical treatment is to prevent further slippage

Answer 3

The primary direction of slippage is medial and anterior

The primary direction of slippage is medial and POSTERIOR