1 week history of right sided hip pain and limp. All starting after report of being struck by a car.
two images of the pelvis show right sided subtle SCFE, post-traumatic in nature.
congenital hip dysplasia
Dx: Traumatic SCFE (Salter Harris Type 1 Fracture for the Femoral Head)
Dx Confirmed by: radiographs
Surgical pinning, right sided only
In contrast to SCFE due to unknown etiology or obesity, this case was interesting in the fact that an acute traumatic episode caused the SCFE. This makes this a Type 1 Salter Harris Fracture.
SCFE occurs through the unfused growth plate of the proximal femur where the femoral head slips posteriorly on the femoral neck. Serious consequences of the problem, such as gait disturbance, post-traumatic arthritis, chondrolysis and osteonecrosis of the femoral head can occur, leading to lifelong disability. Prompt diagnosis and treatment of this problem is essential
SCFE occurs in children averaging 12 years in girls and 13-14 years in boys. More than 60% of SCFE patients are in the 90th percentile for weight. Patients present with thigh, knee or hip pain and often an antalgic, out-toed gait. Nearly 85% have had pain at least three weeks at the time of presentation (so called chronic slips) and are able to weight-bear.
Children with SCFE are of preteen or adolescent age, frequently obese. It can be caused by an acute traumatic episode.
On physical exam there is often a decrease in flexion of the affected hip with an obligate outward rotation of the hip as it is brought into flexion
Surgical treatment with single cannulated 6.5 or 7.3 mm screw fixation in situ. The treatment is aimed at closing the proximal femoral physis to avoid future slip.
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