slipped capital femoral epiphysis

Question 1

what is SCFE associated with?

Answer 1

• minor trauma/ injury
• obesity, sedentary teenage boys
• hypothyroidism
• inflammatory conditions

Question 2

what type of slippage can you get?

how is SCFE also categorised?

Answer 2

• acute
• acute on chronic
• chronic: steadily progressive, most common
• stable (90%) can walk
• unstable (10%) patient can’t walk

Question 3

how might the child present?

Answer 3

• limping
• antalgic gait
• external rotation of the leg
• hip motion limited

Question 4

what investigations would you do?

management?

complications?

Answer 4

• AP and “frog leg” lateral XR
• shows displacement of femoral head
• don’t let patient walk
• analgesia and orthopaedic referral
• avascular necrosis of epiphysis

Question 5

what is the most common cause of limp in young children?

Answer 5

• transient synovitis/ irritable hip

Question 6

what age group does transient synovitis occur in ?

what should you not miss as a differential?

Answer 6

• 2 - 8 years

- septic arthritis

Question 7

what is TS often preceded by?

what features are there of TS?

Answer 7

• URTI
• sudden onset limp
• acute onset hip/ knee pain, no weight bearing
• limited hip movement
• normal XR and bloods

Question 8

how should you manage TS?

Answer 8

• lasts 2 weeks
• rest and analgesia
• no long term complications

Question 9

who does osgood- schlatter disease commonly affect?

Answer 9

• active adolescents

- small avulsion fractures from contractions of quadriceps at proximal tibial apophysis

Question 10

how would an osgood schlatter present?

Answer 10

• gradual onset of pain
• swelling below the knee
• relieved by rest
• tenderness and swelling at tibial tuberosity
• analgesia