Slipped Capital Femoral Epiphysis in Atypical Patients

Whyte, Noelle; Sullivan, Christopher

doi:10.3928/00904481-20160310-01

Cited by 12 publications

(20 citation statements)

References 9 publications

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“…Characteristically, SCFE occurs when the metaphysis migrates anterosuperiorly relative to the physis. 4 In severe cases, this is easily seen in an AP view of a hip. However, in mild cases where minimal displacement occurs, this is not obvious and frog-leg lateral views of the hip become important.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosing slipped capital femoral epiphysis amongst various medical specialists

Lam

Boenerjous

et al. 2018

Journal of Children's Orthopaedics

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PurposeTo evaluate sensitivity, specificity and accuracy of a radiographic slipped capital femoral epiphysis (SCFE)-diagnosis among medical specialists.MethodsThree paediatricians, three paediatric radiologists and three paediatric orthopaedic surgeons completed two rounds of a survey of anteroposterior and frog-leg lateral radiographs of patients with a diagnosis of SCFE (25), femoroacetabular impingement (four), Legg-Calvé-Perthes (11) or no hip pathology (ten). Intra- and interobserver agreement among specialties regarding the diagnosis of a SCFE were assessed using Cohen’s kappa coefficient (κ). Diagnostic accuracy of SCFE relative to the benchmark, a combination of the radiographic diagnosis based on Klein’s line, clinical symptoms and surgical treatment, was assessed computing sensitivity, specificity and accuracy.ResultsIntraobserver agreement between the surveys was moderate among paediatricians (κ-range, 0.44 to 0.52), moderate to almost perfect among orthopaedic surgeons (κ-range, 0.79 to 0.88) and almost perfect among paediatric radiologists (κ-range, 0.83 to 1.00). Interobserver agreement for survey 1 and 2 was slight among paediatricians (mean κ, 0.19), substantial among orthopaedic surgeons (mean κ, 0.77) and almost perfect among paediatric radiologists (mean κ, 0.86). Sensitivity of SCFE-diagnosis was high among radiologists and orthopaedic surgeons (88% to 100% for both specialties), but lower for paediatricians (24% to 76%). Specificity was high among radiologists and orthopaedic surgeons (72% to 84%), however, variable among paediatricians (56% to 80%). Accuracy of a SCFE-diagnosis was highest in radiologists (84% to 92%), followed by orthopaedic surgeons (80% to 88%) and paediatricians (48% to 78%).ConclusionSCFE can be detected on radiographs by different medical specialties. Intra- and interobserver agreement, specificity, sensitivity and accuracy for radiographic SCFE-diagnosis amongst paediatric radiologists and orthopaedic surgeons are better than that of general paediatricians.Level of EvidenceII

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Section: Discussionmentioning

confidence: 99%

“…Less common associated disorders include endocrinopathies such as hypothyroidism, hypogonadal states and renal osteodystrophy. 4 An impact of environmental and genetic factors on the development of SCFE has also been suggested. 3 …”

Section: Introductionmentioning

confidence: 99%

Diagnosing slipped capital femoral epiphysis amongst various medical specialists

Lam

Boenerjous

et al. 2018

Journal of Children's Orthopaedics

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“…A review of current literature shows that the presence of endocrine disorders in children with SCFE is significantly higher than in the general pediatric population [ 3 ]. Various papers have emphasized the need to consider metabolic and endocrine disorders as primary diagnoses for SCFE, especially in patients of noticeable short stature and sexual immaturity [ 2 - 3 , 10 ]. We recommend that a pituitary tumor be considered as a possible underlying cause in children presenting with SCFE.…”

Section: Discussionmentioning

confidence: 99%

Suprasellar Germinoma Presenting with Slipped Capital Femoral Epiphysis: Case Report

Sankar¹,

Kyono²,

Raffel³

et al. 2017

Cureus

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Slipped capital femoral epiphysis (SCFE) is a fracture that results from displacement of the proximal femoral epiphysis from the femoral neck. SCFE can be caused by various endocrinopathies that lead to bone weakening in both adult and pediatric patients. We report a rare case of suprasellar germinoma presenting with SCFE in an 11-year-old female patient. The findings of this case further support the need to consider pituitary lesions as the underlying cause of endocrine deficiences leading to SCFE.

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“…5,6 The other varieties of SCFE are atypical and are associated with various pediatric endocrine and metabolic disorders as well as chronic diseases. 7 Loader et al reviewed 85 cases in which endocrine disorders were associated with SCFE and found that 40% had hypothyroidism, 25% had growth hormone deficiency and the remaining 35% had other conditions such as panhypopituitarism and hyperparathyroidism. 8 In that report, 5.2 to 6.9% of patients with SCFE were associated with endocrine disorders.…”

Section: Introductionmentioning

confidence: 99%

“…9 In literature, other recognized causes of atypical SCFE include growth hormone therapy, renal osteodystrophy, vitamin D deficiency, irradiation therapy, Down syndrome and Klinefelter mosaic state. [7][8][9][10][11] The association between SCFE and overweight/ obesity is better recognized than its association with various endocrine disorders. Therefore, in clinical practice, the latter association is more likely to be overlooked, 5 resulting in missed/delayed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Graves’disease and slipped capital femoral epiphysis: a rare association

Onyiriuka¹

2018

EMIJ

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Introduction: Slipped capital femoral epiphysis (SCFE) is rare and its co-existence with Graves' disease in an individual is even rarer. The aim of this report is to create further awareness among physicians on this association and present a short review of the literature. Case presentation:We report on a 12-year-old tall, thin, rapidly growing adolescent Nigerian boy with Graves' disease associated with SCFE and whose diagnosis was initially missed. The patient had three medical consultations before the correct diagnosis was made, probably because of the rarity of the association between the two clinical conditions. Conclusion: SCFE should always be considered in any adolescent presenting with limping and/or hip pain, irrespective of the weight status of the patient, particularly in the presence of an endocrine disorder.

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Slipped Capital Femoral Epiphysis in Atypical Patients

Cited by 12 publications

References 9 publications

Diagnosing slipped capital femoral epiphysis amongst various medical specialists

Diagnosing slipped capital femoral epiphysis amongst various medical specialists

Suprasellar Germinoma Presenting with Slipped Capital Femoral Epiphysis: Case Report

Graves’disease and slipped capital femoral epiphysis: a rare association

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