Imaging powerpoint presentation SCFE

Imaging in the Diagnosis of Slipped Capital Femoral Epiphysis (SCFE) February 12, 2012: 

Imaging in the Diagnosis of Slipped Capital Femoral Epiphysis (SCFE) February 12, 2012 Jenna Bazemore, SPT Pamela Breckenridge, SPT Morgan Crutchfield, SPT

Slipped Capital Femoral Epiphysis (SCFE) : 

Inferior/ Posterior displacement of proximal femoral head on the metaphysis in adolescents Slippage occurs at physeal plate, and can only take place BEFORE the closure of growth plate, often occurring during a growth spurt Slipped Capital Femoral Epiphysis (SCFE)

Signs and Symptoms: 

Aching pain in groin, hip, medial thigh and/or knee pain Antalgic / Trendelenburg gait Decreased weight bearing on involved limb External rotation of involved limb Limited internal rotation, flexion, abduction May exhibit small leg length discrepancy Whitman’s Sign Signs and Symptoms

Etiology: 

Etiology Most causes are IDIOPATHIC Risk factors include, obesity, physeal orientation, physeal abnormalaties , hormonal imbalances Can be due related to renal osteodystrophy , radiation therapy, or endocrine disorders

Incidence: 

1-3/100,000 children M > F Age of Onset Boys: 12-16 years old Girls: 10-13 years old 20-30% have bilateral involvement 60% of pts are over the 95 th percentile for weight Most susceptible: African American and Polynesian descent Incidence

ONSET: 

ONSET Chronic Gradual onset, over 3 or more weeks Acute Sudden onset, less than 3 weeks Acute on Chronic Symptoms gradually build, followed by acute exacerbation

Diagnosis: 

Diagnosis History Physical Examination Imaging

Prognosis: 

Overall prognosis good EARLY DETECTION and treatment is imperative to improve prognosis Complications include femoral head avascular necrosis, penetration of surgical fixation pin into the joint space, and degenerative hip arthritis that commonly develops over time. Prognosis

Role of Imaging: 

Role of Imaging Confirm Diagnosis Classify Grade of Slippage Guide Treatment

Imaging of Choice for SCFE: 

Imaging of Choice for SCFE X-ray is the best imaging of choice Stable vs. Unstable Ultrasound MRI

Imaging of Choice Cont.: 

Imaging of Choice Cont. Stable SCFE: anteroposterior and frog-lateral pelvic radiographs. (4) Unstable SCFE: an anteroposterior pelvic radiograph, a cross-table lateral radiograph of the involved hip and either a frog-lateral or a cross-table lateral radiograph of the opposite hip are recommended. (4)

Classification: 

Classification “pre-slip”: no displacement but shows changes in the epiphyseal plate Grade I: femoral head is displaced up to 1/3 the width of the neck Grade II: femoral head is displaced more than 1/3 but less than ½ the width of the neck Grade III: femoral head is displaced more than one half the width of the neck Nichols, L. Pediatric Physical Therapy Course Notes. St. Augustine, FL: The University of St. Augustine for Health Science; Summer 2011.

Medical Management of SCFE: 

Medical Management of SCFE Stable SCFE Pin in situ fixation with a single central screw. (4) Spica Cast Unstable SCFE Controversial (4).

Physical Therapy Management: post-surgery: 

Physical Therapy Management: post-surgery No spica cast: Begin ambulation within 2-10 days after surgery with NWB or TDWB for about 6 weeks Gradually increase WB to FWB over the next 6 weeks The physician will indicate when post-surgical strengthening activities can begin May take 1-2 years to regain good pain-free ROM following chronic slip with pinning in situ Spica cast: Educate parents/caregivers how to transfer and position child Teach child UE exercises to maintain strength and mobility Post cast removal focus on active and passive ROM Begin gait training when LE strength and ROM are adequate for ambulation and WB status is known Nichols, L. Pediatric Physical Therapy Course Notes. St. Augustine, FL: The University of St. Augustine for Health Science; Summer 2011.

Radiograph: 

Radiograph http://www.bmj.com/highwire/filestream/437193/field_highwire_fragment_image_l/0.jpg

ABC’s : 

ABC’s Alignment Left femoral head malalignment Bone Density Less density in the neck of left femur Bony growth surrounding slippage Cartilage space Epiphyseal plate not smooth margins

PowerPoint Presentation: 

Soft Tissues Minimal atrophy of left hip and thigh musculature

T1 and T2 weighted MRI: 

T1 and T2 weighted MRI http://www.mypacs.net/cases/SLIPPED-CAPITAL-FEMORAL-EPIPHYSIS-899184.html

Questions : 

Questions What (if any) are contraindications for the individual with slipped capital femoral epiphysis in the radiographic image used in this presentation? Describe the differences between an anterioposterior vs. frog-leg radiograph.

References: 

References Gholve PA, Cameron DB, Millis MB. Slipped capital femoral epiphysis update. Curr Opin Pediatr . Feb 2009;21(1):39-45. Harland U, Krappel FA. Value of ultrasound, CT, and MRI in the diagnosis of slipped capital femoral epiphysis (SCFE). Orthpade . Sep 2002;31(9):851-861. Loder RT. Slipped Capital Femoral Epiphysis. Am Fam Physician. May 1998;57(9):2135-2142. Nichols, L. Pediatric Physical Therapy Course Notes. St. Augustine, FL: The University of St. Augustine for Health Science; Summer 2011.

References, contd: 

References, contd 5. Umans , Hilary. M.D. "Slipped capital femoral epiphysis: a physeal lesion diagnosed by MRI, with radiographic and CT correlation". Skeletal Radiology (1998) 27:139±144