16 - Hip Disorders - D3

16 - Hip Disorders - D3 - By Bashar AlBy Saify I. S lippe d...

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By Bashar Al- By Bashar Al- Saify Saify
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I. Slipped capital femoral epiphys is (SCFE) II. Traumatic hip dis location III. Os teoarthritis
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aka "S lipped upper femoral epiphysis " is a medical term referring to s lippage s lippage of the overlying epiphysis of proximal femur pos teriorly and inferiorly due to weaknes s of the growth plate . Most often, it develops during periods of
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A Klein line is a line drawn along the superior border of the femoral neck that would normally pass through a portion of the femoral head. If not, slipped capital femoral epiphysis is diagnosed. The patient's left hip (arrow) shows that a slight shift of the head of the femur occurred through the growth plate.
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most common in the adoles cent period (boys aged 10-16 y, girls aged 12-14 y). Males have 2.4 times the risk as females. Obes ity is a risk factor because it places more shear forces around the proximal growth plate in the hip at risk. Bilateral slippage is common ( but the left hip is affected more commonly than the 1. Ris k Factors
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2. Etiology 1. Overweight 2. Endocrine disorders ( e.g adiposogenital dystrophy, primary or secondary hypothyroidism ). 3. Deficiency or increase of androgens . 4. Acute trauma . S lipping of the upper femoral epiphysis occurs predominantly in obes e children with underdeveloped s exual characteristics and less commonly, in tall, thin children.
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3. Pathology The slip occurs in the hypertrophic zone of the growth plate . 70% s low and progres s ive (This is gradual, with slowly increasing symptoms over a period of weeks or even months . In chronic slipping, there may be no his tory of trauma and the s ymptoms are often quite mild ). 30% acute due to trauma (Least common, this usually follows s evere trauma such as a fall from a height ). If the slip is sever anterior retinacular ves s els are torn avas cular necros is . Physeal slip → premature fus ion of the epiphysis
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1. Pain : in the groin and around the knee. 2. Limp (intermittent). 3. Shortening of the affected limb (1-2 cm). 4. The limb is in external rotation . 5. Flexion, abduction, medial rotation are limited . 6. External rotation, adduction are increas ed . 4. Clinical Features
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Ultra s ound : AP X-ray : ( melting ice cream cone) 1. Widening of the growth plate . 2. Trethowan’s s ign : Line up superior margin of neck should intersect epiphysis ( usually 20% of the femoral head lateral to this line) 3. Capeners s ign : In pelvic AP view in the normal hip, the posterior acetabular margin cuts across the medial corner of the upper femoral metaphysis. With slipping, the entire metaphysis is lateral to the posterior acetabular margin Lateral X-ray : Slip Posterior horn of the neck is lower than anterior horn. 5. Diagnos is
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16 - Hip Disorders - D3 - By Bashar AlBy Saify I. S lippe d...

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