Image Quiz
Hip Pain in a Ten-Year-Old Girl Five Months After in Situ Screw Fixation for Stable Slipped Capital Femoral Epiphysis1
A ten-year-old girl with pain in the left hip and decreased hip motion was evaluated five months after she had been treated elsewhere for a stable left slipped capital femoral epiphysis with in situ screw fixation. The procedure had been performed one month following the onset of symptoms, and two screws had been used to stabilize the slipped capital femoral epiphysis (Figs. 1, 2-A, and 2-B).
Fig. 1 |
Initial frog-leg lateral radiograph of left hip, demonstrating a slipped capital femoral epiphysis. This ten-year-old girl had moderate pain and could walk; thus, the slip was classified as stable.
For larger view, click on image |
Fig. 2-A |
Fig. 2-B |
Figs. 2-A and 2-B Anteroposterior (Fig. 2-A) and frog-leg lateral (Fig. 2-B) radiographs of the left hip after the initial pinning. The screw tips appear to be in the correct position.
For larger view, click on image |
The condition of the patient failed to improve after the initial operation; instead, she had increasing hip pain, loss of hip motion, and an externally rotated hip posture. She had no pain at rest and was still an active swimmer. Physical examination demonstrated limited left hip flexion to 45° and pain with resisted straight-leg raising. The rotational arc of motion was 30° (30° external to 60° external) and painful. Anteroposterior and frog-leg lateral radiographs demonstrated that the screw tips were near the joint surface.
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