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Limb shortening, decreased hip flexion and decreased hip internal rotation
80%
1475/1850
Limb lengthening, increased hip flexion, and increased hip internal rotation
1%
21/1850
Limb lengthening, decreased hip flexion, and decreased hip external rotation
2%
44/1850
Limb shortening, decreased hip flexion, and increased hip internal rotation
7%
137/1850
Limb shortening, increased hip flexion, and decreased hip internal rotation
9%
161/1850
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This patient underwent in-situ pinning of an unstable slipped capital femoral epiphysis (SCFE). Forceful manipulation is not indicated because it is associated with an increased risk of osteonecrosis. Patients with SCFE can present with an out-toeing gait, limb shortening, decreased hip flexion, decreased hip abduction, and decreased hip internal rotation. A frequently seen sign associated with SCFE includes obligatory abduction and external rotation during passive hip flexion from an extended position. Level 4 evidence by Song et al reviewed 20 unilateral SCFE patients. With increasing slip angles, passive hip flexion, hip abduction, and internal rotation decreased significantly. The study by Rab used computer modeling of SCFE patients to determine that posterior epiphyseal displacement in the plane of the physis is the etiology for the resultant deformities found in SCFE. Additionally, they found that sitting increases impingement for all slip geometries, requiring proportionately greater external rotation and accounting for why patients feel better to cross the affected leg while sitting in a chair.
4.1
(20)
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