Acetabulotrochanteric Distance in Slipped Capital Femoral Epiphysis

Abstract

Level IV.

Causes of Delayed Diagnosis of Slipped Capital Femoral Epiphysis: The Importance of the Frog Lateral Pelvis Projection

“…Studies report a mean delay in the diagnosis of SCFE of about five to 10 months but extremes of up to three years from onset to diagnosis have also been reported [2][3][16][17][18][19][20]. A greater delay results in a slip of higher severity and worse long-term outcomes after treatment [2][3][7][8]12,14,[16][17][18][19][20][24][25]. Kocher found a significant relationship between a delay in diagnosis and slip severity (<30⁰: 10 weeks, 30⁰-50⁰: 14.4 weeks, >50⁰: 20.6 weeks) [17].…”

“…Thus, a greater than 2 mm sideto-side difference of the transection of the capital epiphysis by the Klein line increases the sensitivity of the AP pelvis view to detect an SCFE to 79% [27]. Song et al showed that the sensitivity of the AP pelvis view to diagnose a slip increases to 76% if the acetabulotrochanteric distance is greater than 2mm [19]. Bloomberg et al found that a wide, irregular physis is the most reliable sign of an early slip on the AP pelvis projection.…”

“…On the other hand, slip severity correlates strongly with slip chronicity [16][17]. Early diagnosis and treatment is the only effective way to prevent further slippage of the capital femoral epiphysis and to obtain satisfactory long-term results with in-situ stabilization of the slipped physis [2][3]5,[7][8][16][17][18][19][20].…”

“…When the diagnosis is finally set, the slip has usually progressed to a grade of higher severity, implying an increased risk of FAI and less favorable outcomes [5]. Delayed diagnosis of SCFE is universally reported, irrelevant of time and place [2][3]5,[7][8]12,[16][17][18][19][20]. Almost a century ago, Key reported a mean delay of 14.6 months to diagnose SCFE [3].…”

“…Almost a century ago, Key reported a mean delay of 14.6 months to diagnose SCFE [3]. No real progress has been made since then towards a timely diagnosis and treatment of SCFE [2][3]5,[7][8]12,[16][17][18][19][20].…”