Dados do Trabalho

Título

Slipped Capital Femoral Epiphysis (SCFE): a case presentation.

Descrição sucinta do(s) objetivo(s)

This current case aims to investigate and comprehensively report on the clinical presentation, diagnosis, treatment, and evolution of a hip epiphysis slip.

História clínica

Male patient, adolescent, previously healthy, reports thigh and knee pain with progressive worsening over the last 7 months, resulting in a limping gait. In the last 15 days, after a soccer game, he experienced increased pain and inability to walk, as well as the inability to support the weight of the lower limb.

Discussão e diagnóstico

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents, occurring in 10.8 per 100,000 children. SCFE usually occurs in those 8 to 15 years of age and is one of the most commonly missed diagnoses in children. SCFE is classified as stable or unstable based on the stability of the physis. It is associated with obesity, growth spurts, and (occasionally) endocrine abnormalities such as hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism.

The diagnosis is usually confirmed by X-rays that demonstrate an inferior and posterior slip of the proximal femoral epiphysis relative to the metaphysis. The gradual slip shows radiographic signs of remodeling in the superior and anterior femoral metaphysis, and periosteal new bone formation at the posterior and inferior epiphyseal-metaphyseal junction. Other early radiographic signs of Slipped Capital Femoral Epiphysis (SCFE) include the Steel metaphyseal blanch sign and Klein's line. The Steel metaphyseal blanch sign is a radiographic double density seen on the anteroposterior view at the level of the metaphysis; this double density reflects the posterior cortical lip of the epiphysis as it begins to slip posteriorly and is radiographically superimposed upon the metaphyseal density. Klein's line is drawn along the anterior or superior aspect of the femoral neck; the epiphysis should normally intersect this line. In an early SCFE, the epiphysis will be flush with or even below this line.

Conclusões

The discussion addresses the complexity of diagnosing hip epiphysiolysis, emphasizing the importance of clinical suspicion and the use of imaging studies. It highlights the need to individualize treatment, taking into consideration factors such as age, stability of the slippage, and specific clinical conditions.

Palavras Chave

Slipped Capital Femoral Epiphysis; Slip; Epiphysiolysis

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