Slipped Capital Femoral Epiphysis - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 1 жов 2024
- Dr. Ebraheim’s educational animated video describes the condition of slip of the femoral capital epiphysis.
What is the diagnosis? 12 year old African American boy with medial side knee pain.
What will the physician do next? Do an examination of the knee and do not forget to check the hip.
Obligate external rotation of the hip: external rotation and abduction of the thigh with attempted flexion.
Then order X-rays: get an x-ray of the hip. AP view x-ray appears normal.
What do you need to order next? Get frog leg lateral view x-ray.
What is the treatment? Percutaneous in situ screw fixation.
What if the child is 10 years old with knee pain?
What will the physician do next? Do an examination of the knee followed by examination of the hip. Check for limitation of internal rotation of the hip. Which hip? Both hips.
What is the most appropriate study for this patient? Get an x-ray for both hips. AP view and frog leg lateral view x-rays for both hips.
Get metabolic work up for hypothyroidism and BUN/creatinine especially if the patient is less than 10 years old or the patient’s weight is less than 50%. All patients will hypothyroidism develop epiphyseal slip.
Endocrine disorders in young patients= bilateral slip of the capital femoral epiphysis.
Hypothyroidism is the most likely finding with bilateral cases.
What is next? Fix both hips by percutaneous screws in situ.
Slipping of the capital femoral epiphysis usually occurs in:
•Males
•African Americans
•13 years old boys
•12 years old girls
•Can be bilateral in up to 50% of the cases
Young patients could have endocrine disorders such as hypothyroidism or renal problems. Always rule out the possibility of a slipped epiphysis relative to the femoral neck in children with knee pain who are 12-13 years of age. Mechanical failure of the growth plate occurs at the hypertrophic zone. Mechanical stress exceeds the strength of the growth plate.
Early diagnosis is important. The condition is either stable or unstable (Loder classification).
•Stable: the child is able to bear weight with or without crutches. Osteonecrosis occurs in about 5-10% of cases if it is stable.
•Unstable: unable to ambulate even with being on crutches. Osteonecrosis occurs in about 50% of cases if it is unstable. Avoid forcible manipulation.
Symptoms/examination
•Usually groin and thigh pain with knee pain in about 20% of cases
•Obligatory external rotation during flexion of the hip
•Loss of internal rotation of the hip
•Antalgic gait
Diagnosis is difficult. The onset of chronic slip is insidious. The pain is referred to the knee.
Imaging
The condition sometimes does not show well on AP view x-ray (may appear normal).
Must obtain both AP view and frog-leg lateral view x-rays of the hip.
Bilateral in young children 10 years old or younger.
It is best to screen slip of the epiphysis by positioning the patient prone and access the asymmetry with internal rotation of the hip. Kline’s line will show the slip of the epiphysis on AP view x-rays. If X-ray is negative, MRI can be helpful to diagnose the pre-slip condition by showing widening of the growth plate and edema at the metaphysis.
Slipping of the epiphysis may be mild, moderate or severe. The femoral head is posteriorly and inferiorly. The femoral neck displaces anteriorly and externally rotates.
Treatment if using only one screw, start on the anterior neck and cross perpendicular to the physis with a minimum of three threads. Confirm by fluoroscopy that the screw does not penetrate the hip joint. Avoid placing screws in the posterosuperior neck to avoid the blood supply and risk of AVN. Do not place the screw through the greater trochanter. Do pinning of a slip, not pinning of a hip.
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I had it as a kid I really don't think race has anything to do with it we are just unlucky. I had both hips pinned and the fix lasted about 20 years I had to get my (L) hip redone in 2013 and am looking to get my (R) hip done early to mid 2019. So if your young stay active as possible it will make it easier as you get older I'm 38 still play soccer basketball and workout so the more fit you are the better chance of not have the surgery again.
Sir i want to ask some questions
An excellent animation sir. As always thank you blessings and peace
شكرا جزيلا يا دكتور نبيل على الشرح المفيد و المبسط بدقائق معدودة , جزاك الله خير على وقتك و جهدك
I suffered a difficult slipped capitol femoral epiphysis at age fourteen. I was perhaps the opposite of obese, and with no family history.
I had the internal fixation w/ four 6-inch "Nails."
Early on thereafter I developed severe osteoarthritis and avascular necrosis.
After a couple decades of chronic, severe pain and many limitations, I then suffered a disastrous experience with pain management specialists.
This SCFE ruined my life.
Now 67 years old, it is a miracle I am still here amoungst the land of the living...
Nice nd helpful vedeo sir
I walked for probably a year when I was 14 with my hip like this. Not lnowing what was wrong. Finally to find out I was diagnosed with SCFE. I was a late case. The left leg that was effected growth plate closed. Ending up with my right leg close to a inch longer. I had 3 pins put in my hip and they were tooken out after a year. Honestly I am here cause I'm in pain in that area again and it has a toppling effect. Anyone who gets this operation needs extensive physical therapy and follow a regimen for life. It causes alot of exactly what he said back pain, pelvis, hip,butt. Anyone else have this operation and know where or how to get help? Im 44 had it at 15. I don't think our health care values P/T enough and allows a 15 yr old to much responsibility. Insurances should teach preventive maintenance for people who are just going to have problems years later in life and are not guided in the right direction what to do. All I know this hip operation effected my life poorly in alot of ways. Its a serious operation.
I'm now 45, just experiencing serve pain for the first time since the operation which was 31 years ago
😞
I had this surgery when I was 9yo, on both sides of the hip, today I am 38 and about to get a left hip replacement due to osteoarthritis... I still have the original pins inserted, one in wich side hip. The pain is real, especially if you get overweight 😢
Great video, but there has to be better music/background noise to put in.
No music!!!
My hips pinned /wired at age 10 (1980) due to radiation damage!
2nd only in U.K. to have SCFE /hips pinned as an outcome of radiation treatment as a baby (1972). Back then 3 pins/wires were placed per hip and removed after 12 months. Followed by 6 months in wheelchair and 6 months on crutches. Another girl had (the 1st to have it done) was of similar age and similar pelvic radiation treatment as a toddler). She had similar procedure but her hips were pinned one at a time, she was placed in traction for a few weeks then in plaster for 3 months.
How times change with time &knowledge. I suppose we were the guinea pigs for future suffers. 🥰 How to do and how not to do.
I’m 52 now. With quite severe pain due to hips not growing properly, also due to radiation. My pelvis still size of a 6-7 year old on adult body. Strange to look at but fascinating how the body adapts.
I'm sorry to learn of your experience.
I have suffered tremendously throughout life too as a result of SCFE.
Now 67 years old, and am no longer a candidate for a total hip arthroplasty...
Hi.. This video is great.. It is easy to understand. Thank u. And keep it up 😊
شرح رهيب وابداع خيالي
اففضل فيديو شفته ❤
ياريت دكتورنا نبيل تشرح المواضيع اللي تهمنا كاطباء عموم واللي تعتبر emergncy in ortho
واي تاخير فيها يسبب ضرر وكذا
بهذي الطريقة الرهيبة جدا والشرح المبسط
ربنا يحفظك ويطول عمرك
ويبارك في ذريتك❤
Why was the femur not realigned with the epiphsis before screwed in?
I’ve got it 👍🏻👍🏻
This is a good video
i like your videos
I have this, rather uncomfortable to live with a screw of 1 decimeter through your hip. But it made me able to walk again so i’m happy to have gotten it done.
IKEA Catalogue I’ve had it in my hip for over 1 year now, it’s really annoying
Whats up fellas. Im here to tell you guys keep on physical therapy hip flexion. I had 3 pins but tooken out.This is 35 yrs ago . My advice exercise and get that core strong. Cause everyone I hear from has nothing but pain yrs later. Best of luck to u both.
@@seanheffron8444 sir i want to ask you some question
@@venugopalaiyar8416 whats up? Sorry just saw this.
@@seanheffron8444 i think i am suffering from this problem
Excellent video
My growth plates are almost closed so I’m taking hGH before the window closes. I read on the little paper that comes with the shots that you could get this, I’ve been taking it each day once a day for about 4 weeks now and today I got a pain that seems to come right from that spot.
I might be paranoid, specially more so since the pain came out of a sudden and on both my legs. Any thoughts?
I just had some leg and butt workout two days ago so I’m thinking the pain is coming from the tendon in my inner thigh.
Thank you 🙏
no one could explain better.
Great video.. Thanks a lot!
I love ur vedios dr nabil...helped me alot
I was experiencing alot of pain on my both hip when I was 14 as I was showing symptoms of a scfe as my younger brother was recovering from his I didn't get the frog lateral x ray wich caused my hip to grow on the outer side of my hip joint where it had slipped to that was happening over 14 month the pain I experienced caused me to try and take my life 15 16 and 17 sometimes I still struggle with suicide this has ruined a lot of opportunities in my life such as I was a full time painter and decorater betime I was 16 and I'm only 20 i have had 5 operations but the pain will always be there and is only going to get worse and been told to not do any painting and decorating it has had a deviating impact on my life and family's but I still find away to try be a bit happy such as sit with my friends that know of my condition and help me by being there for me and my family most of all of I didn't say to my dad at work that day how I was feeling I wouldn't be here today so I hope that to anyone who reads this that you are not alone and to anyone who wants to chat about what we're going through I would love that cause I don't know anyone who can relate to this pain and it would probably help for us to try and help each other by just talking and sharing how this horrible condition can change our live in a heartbeat so for anyone who has read this thank you and get in touch by just replying to this stay strong 💪💪
informative.
Awesome! thank you
Dr Ebraheim your videos are the best.
I love your videos. It has helped me a lot in school .PTA soon to be
Camila Andrade I know this is late but good lick remember I had one and screw size does vary I think. also they are at least 20 thousand mabey hope that help
nice ..please change music
Sxv Vccs learn to mute
thank you...
now how much would a surgery for this cost? estimate
Psycho Gaming Well, although this is 4 months old, my surgery was over 30 grand. Probably differs though.
Well if u have medical they will cover that for you I just got out of my scfe surgery it went great
Mine was about 20 thousand but it was one of the smaller screws
Psycho Gaming luckily I’m in the uk I did not pay nothing
ZWOP lucky
Always you are our role model
Nice ,excellent and informative video,,,helped me a lot 💜🤍❤️
The problem is that I have it and I'm white... apparently the chances are 1 every 50,000... 1 like=1 prayer
Tristyboy Gaming I'm white and a man that is very low
Tristyboy Gaming I’m white and I’ve had it I got my hip pinned in January and I had the surgery and it. I was not walking for 6 weeks and now they think I have to get my other one pinned
Chelsea Parks holy crap I only have 1.... Sorry that has to happen
lol okay...
Pathogenesis sir?
Thank you
thx
Yes rod kab tak nikalte h
amazing
👍
thank you
My7 year old have perthesis is it same
perthe's disease is different