summary Slipped Capital Femoral Epiphysis, is a common condition of the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis, and is most commonly seen in adolescent obese males. Diagnosis can be confirmed with radiographs of the hip. Treatment is usually percutaneous pin fixation. Contralateral pinning is indicated for patients at high risk, such as those with an initial slip at age < 10, obese males, and those with endocrine disorders. Epidemiology Incidence most common disorder affecting adolescent hips 10 per 100,000 Demographics more common in obese children males male to female ratio is 2:1.4 specific ethnicities including African Americans, Pacific islanders, Latinos periods of rapid growth 10-16 years of age average age range is 12-13.4 for boys 11.2-12.2 for girls occurs when going through puberty Anatomic location left hip is a more common location can be bilateral in 17% to 50% (average of 25%) Risk factors obesity single greatest risk factor recent data shows a trend towards younger age and increased frequency of bilateral presentation may be related to increased rates of childhood obesity acetabular retroversion and femoral retroversion secondary to increased mechanical shearing forces at the physis history of previous radiation therapy to the femoral head region Etiology Pathophysiology mechanism occurs due to axial and rotational mechanical forces which act on a susceptible physis direction of slip/angulation metaphysis translates anterior and externally rotates epiphysis remains in the acetabulum and lies posterior/inferior to the translated metaphysis pathoanatomy slippage occurs though the hypertrophic zone of the physis histology sections reveal granulation tissue between the columns in the hypertrophic zone cartilage in the hypertrophic zone acts as a weak spot increased risk in adolescence because: the perichondrial ring thins and weakens undulating mammillary processes in physis unlocks, further destabilizing the physis physis is still vertical in this age group (160° at birth to 125° at skeletal maturity), which results in increased shearing forces the epiphyseal tubercle can provide a rotational pivot point this represents an anatomic structure in the posterior superior epiphysis that shrinks with skeletal maturity similar to Salter-Harris type I fracture, but may differ based on antecedent epiphysiolysis slower displacement periosteum remains intact (chronic SCFE) in acute SCFE, periosteum can be partially torn anteriorly over the prominent metaphysis Associated conditions endocrine disorders associated conditions hypothyroidism most common etiology of nonidiopathic SCFE labs: elevated TSH renal osteodystrophy labs: elevated BUN and creatinine growth hormone deficiency panhypopituitarism endocrine workup indicated if child is < 10 years old weight is < 50th percentile Down syndrome ANATOMY Osteology normal proximal femur neck shaft-angle is 130 +/- 7° normal proximal femur anteversion is 10 +/- 7° proximal femur consists of tensile and compressive trabecular groups proximal femoral physis is where pathology occurs with slip of epiphysis and metaphysis Ligaments iliofemoral, ischiofemoral and pubofemoral ligaments attach to outer hip capsule and help to prevent excessive hip motion Blood supply a confluence of arteries which forms an extracapsular arterial ring that divides into the ascending cervical arteries which supply the femoral neck and head via perforators main blood supply in adolescents and adults is the medial femoral circumflex artery which is derived from the lateral epiphyseal artery lateral femoral circumflex contributes to anterior arterial ring superior and inferior gluteal arteries also give small contributions to arterial ring artery of ligamentum teres comes from obturator or medial femoral circumflex plays a relatively insignificant role in blood supply initial slip as well as iatrogenic causes are thought to increase the risk of damage to blood supply unstable SCFE at greater risk for blood supply injury Biomechanics in double-leg stance, the force vector through hip is vertical and in single-leg stance it is parallel to the neck and head axial/rotational forces through physis place stress on weak hypertrophic zone in population at risk Classification Loder classification Loder Classification Based on ability to bear weight Stable Able to bear weight with or without crutches Minimal risk of osteonecrosis (<10%) Unstable Unable to ambulate (not even with crutches) High risk of osteonecrosis (24-47%) Temporal classification Temporal Classification Based on duration of symptoms; rarely used; no prognostic information Acute Symptoms that persist for less than 3 weeks Chronic Symptoms that persist for more than 3 weeks Acute on Chronic Acute exacerbation of long-standing symptoms Southwick Slip Angle Classification epiphyseal-diaphyseal angle can be measured on both AP and frog lateral pelvis radiographs slip angle classification is based on the degree of difference between the affected and unaffected hip if bilateral hips are involved, use 145° as "unaffected" hip reference for AP and 10° as "unaffected" hip reference for lateral Southwick Slip Angle Classification Based on femoral epiphyseal-diaphyseal angle difference Mild < 30° Moderate 30-50° Severe > 50° Grading system Grading System Based on percentage of slippage Grade I 0-33% of slippage Grade II 34-50% of slippage Grade III >50% of slippage Presentation History most commonly atraumatic, although some present after an injury pain has often been present for several months Symptoms pain in hip (52%), groin (14%) and thigh (35%) pain is most common presenting symptom knee pain 15-50% present with knee pain due to pain activation of the medial obturator nerve can lead to missed diagnosis patients prefer to sit in a chair with affected leg crossed over the other duration symptoms are usually present for weeks to several months before diagnosis is made 88% of patients that presented with an unstable SCFE had unappreciated antecedent symptoms for ~42 days prior to diagnosis Physical exam inspection abnormal gait / limp antalgic, waddling, externally rotated gait or Trendelenburg gait abnormal leg alignment externally rotated foot progression angle motion obligatory external rotation during passive flexion of hip (Drehmann sign) due to a combination of synovitis and impingement of the displaced anterior-lateral femoral metaphysis on the acetabular rim loss of hip internal rotation, abduction, and flexion neurovascular weakness and thigh atrophy no true neurovascular compromise usually seen Imaging Radiographs recommended views AP & frog-leg lateral of both hips lateral radiograph is best way to identify a subtle slip if slip is unstable, cross-table lateral should be performed instead of frog-leg findings Klein's line line drawn along superior border femoral neck on AP pelvis will intersect less of the femoral head or not at all in a child with SCFE intersects lateral femoral head in a normal hip due to natural lateral overhang of the epiphysis evaluate for asymmetry between sides "S" sign line drawn along inferior cortical outline of femur in frog-leg lateral view normally extends from proximal femur head/neck junction to the proximal femoral physis but in SCFE there will be a sharp turn or break in continuity of this line epiphysiolysis (growth plate widening or lucency) an early radiographic finding blurring of proximal femoral metaphysis known as the metaphyseal blanch sign of Steel seen on AP due to overlapping of the metaphysis and posteriorly displaced epiphysis MRI indications may help diagnose a preslip condition when radiographs are negative findings growth plate widening edema in metaphysis decreased signal on T1, increased signal on T2 STUDIES Labs if patient is <10 years old, pre-pubertal or has short stature or weight below 50th percentile for age. consist of: TSH free T4 BUN serum creatinine DIFFERENTIAL Septic arthritis/transient synovitis Osteomyelitis Legg-Calve-Perthes disease Developmental dysplasia of hip (DDH) Traumatic injuries adductor strain, AIIS avulsion, pelvic/femur fractures Treatment Operative percutaneous in situ fixation indications both stable and unstable slips technique one vs. two cannulated screws is controversial 2 screw constructs have greater biomechanically stability than the single screw constructs capsulotomy is also controversial goal is to decrease intra-capsular pressure in the setting of unstable SCFE intracapsular pressure in unstable SCFE is double that of control hips, while pressure in stable SCFE is roughly equal to control hips may mitigate intracapsular tamponade, though there is no clear evidence that this reduces AVN rates outcomes good or excellent outcomes in >90% of cases important to understand that fixation does not treat deformity at head/neck junction has led to popularization of other techniques that correct deformity to mitigate long-term risk of chondral damage contralateral hip prophylactic fixation indications controversial current indications are patients at high risk of contralateral slip initial slip at young age (< 10 years-old) those with open triradiate cartilage obese males endocrine disorders (e.g. hypothyroidism) open epiphyseal reduction and fixation indications (controversial) unstable and severe slips technique capital realignment via the Modified Dunn procedure thought to allow acute deformity correction while maintaining blood supply outcomes there is a steep learning curve AVN rates of ~26% (compared to 24% for unstable SCFE treated by in situ screw fixation) overall complication rate is 37% Operative management of symptoms after initial in situ fixation osteochondroplasty indications symptomatic femoroacetabular impingement (FAI) of cam lesion from metaphyseal bump mild to moderate SCFE deformity (slip angle < 30°) techniques arthroscopy limited anterior arthrotomy surgical hip dislocation outcomes no long term data, but appears to show improvements in pain/function low rates of osteonecrosis poor outcomes in cases with pre-existing cartilage damage proximal femoral osteotomy indications painful or function-limiting proximal femoral deformity severe SCFE deformity (slip angle >30- 45°) absence of severe hip osteoarthritis and osteonecrosis technique femoral neck cuneiform osteotomy can provide greatest correction of deformity use is controversial due to high rates of AVN (37%) and osteoarthritis (37%) intertrochanteric (Imhauser) osteotomy most commonly used subtrochanteric (Southwick) osteotomy outcomes good to excellent functional results 2-7% risk of AVN Useful in preventing hip arthrosis long-term Techniques Percutaneous in situ fixation goal to stabilize the epiphysis from further slippage approach percutaneous wire insertion to anterior/lateral thigh using radiographic localization technique reduction a forceful reduction is not indicated and increases risk of osteonecrosis "serendipitous reduction" may be obtained with positioning on OR table number of screws a single cannulated screw typically sufficient and decreases risk of osteonecrosis (compared to multiple screws) some surgeons may add second screw for unstable SCFE screw insertion perpendicular to physis screw starts on the anterior surface of the proximal femur in order to cross perpendicular to the physis and enter into the central portion of the femoral head on both the AP and lateral views starting point should not be medial to intertrochanteric line - will result in impingement between the head of the screw and acetabulum with hip flexion oblique to physis in severe slips, a relatively oblique insertion starting at the intertrochanteric region may be required, rather than perpendicular, to avoid impingement from head of the screw screw position advance until 5 threads cross physis < 5 threads engaged in epiphysis increases risk of progression of slip >10° in one study, those with <5 threads across the epiphysis progressed 41% of the time compared to 0% of those with >= 5 threads into the epiphysis screws should be ~ 5mm from subchondral bone in all views imaging confirm that pin is not penetrating the hip joint there is a higher risk with screw placement in anterior/superior quadrant of femoral head approach-withdraw technique rotate hip from maximal internal rotation or maximal external rotation under live fluoroscopy the screw tip should appear to approach the subchondral bone, then withdraw from it the moment of change from approach to withdraw is the true position of the screw and can be used to insert the screw to appropriate position appropriate position confirmed when screw does not violate articular surface in all views postoperatively stable slips are able to bear weight after fixation unstable slips are typically kept touch-down weight bearing complications osteonecrosis of femoral head residual deformity & limb length discrepancy chondrolysis higher risk if pin placed into anterosuperior femoral head as screw can penetrate the joint here Surgical hip dislocation, open capital realignment and fixation (Modified Dunn procedure) goal to correct the acute proximal femoral deformity and stabilize the epiphysis while protecting the femoral head blood supply technique surgical hip dislocation using the Ganz technique lateral decubitus position straight lateral skin incision centered over greater trochanter interval: gluteus maximus (inferior gluteal n.) / gluteus medius (superior gluteal n.) trochanteric flip osteotomy Z-shaped anterior capsulotomy visualize slip with prominent metaphysis temporarily pin epiphysis with K-wires prior to dislocation bone hook placed around femoral neck for traction ligamentum teres cut hip is dislocated develop retinacular soft tissue flaps incise periosteum along femoral neck extend incision distally to level of lesser trochanter, to reduce tension on retinacular vessels bluntly develop periosteal flaps anteriorly and posteriorly using periosteal elevator mobilize epiphysis starting anterior, use chisel to free epiphysis entirely from metaphysis epiphysis will remain attached to posterior retinacular flap (blood supply) debride metaphysis there will be prominent reactive callus along the posterior metaphysis, which needs to be removed to permit proper epiphyseal reduction and avoid kinking of retinacular vessels reduce epiphysis to metaphysis fixation 2-3 3.0mm K-wires one antegrade starting from fovea across epiphysis one to two retrograde across epiphysis 1 or 2 screws may also be used (6.5mm - 7.3mm) greater trochanter osteotomy must be re-fixed postoperatively touch-down weight bearing for 6 weeks complications osteonecrosis of femoral head theoretically higher risk of disrupting blood supply with this approach Osteochondroplasty goal to address pain and loss of motion related to hip impingement from prominent metaphyseal bump in mild to moderate chronic SCFE deformity technique arthroscopy reserved for mild SCFE deformity remove metaphyseal bump with arthroscopic burr difficult to fully resect superior and lateral portions of the bump limited anterior arthrotomy useful when metaphyseal bump cannot be fully removed arthroscopically performed using modified Smith-Peterson approach surgical hip dislocation moderate SCFE deformity trochanteric flip osteotomy performed hip is dislocated anteriorly curved osteotome used to remove bump burr is used to recreate normal contour of head-neck junction Flexion intertrochanteric (Imhauser) femoral osteotomy goal to correct symptomatic proximal femoral deformity in moderate to severe chronic SCFE deformity technique lateral approach supine position straight lateral skin incision from greater trochanter distal down the femoral shaft reflect vastus lateralis to expose lateral femur transverse osteotomy just proximal to lesser trochanter correction flexion through the osteotomy internal rotation of distal shaft mild valgus correction postoperative touch-down weight bearing for 3 months complications osteonecrosis arthritis Complications Osteonecrosis of femoral head incidence low in stable slips, 24-47% in unstable slips unstable slip is greatest predictor risk factors initial trauma operative complication (4-6%) hardware placement in posterosuperior femoral neck has the greatest risk of disrupting the vascular supply treatment symptomatic management, core decompression, arthroplasty Contralateral hip SCFE incidence 20-80% after unilateral hip fixation most common complication after unilateral surgical fixation risk factors male, obesity, young age of initial slip (< 10 years old, open triradiate cartilage), endocrine disorders treatment/prevention surgical fixation of contralateral hip as needed weight loss programs decreased BMI reduces rates of subsequent contralateral SCFE Chondrolysis incidence 0-2% seen with narrowed joint space, pain, and decreased motion risk factors unrecognized implant penetration of the articular surface occurring in 0-2% of cases pin placement into the anterosuperior quadrant of the femoral head has the highest rate of joint penetration intra-articular hardware penetration best assessed by CT scan decreased prevalence with the use of modern fluoroscopy spica cast immobilization Residual proximal femoral deformity & limb length discrepancy risk factors increased α-angle associated with symptomatic impingement caused by failure of proximal femur to remodel can lead to a pistol-grip deformity treatment intertrochanteric osteotomy (Imhauser) produces flexion, internal rotation and valgus subtrochanteric osteotomy (Southwick) femoral neck cuneiform osteotomy (controversial due to high rate of osteonecrosis and arthritis) Slip progression incidence 1-2% of cases following single screw fixation Delayed diagnosis risk factors increased slip severity knee/thigh pain vs. hip pain stable slips Medicaid insurance Infection incidence 0-2% Chronic pain incidence 5-10% Degenerative arthritis Labral tearing and degeneration risk factors seen with high anterior and medial 2nd screw in-situ fixation if screw lies medial to intertrochanteric line on AP radiograph, has increased risk of impingement on acetabulum and labrum with hip flexion
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Percutaneous Pinning of SCFE Rachel Goldstein Paul Choi Pediatrics - Slipped Capital Femoral Epiphysis (SCFE)
QUESTIONS 1 of 42 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ15.70) A 13-year-old overweight patient presents to the emergency department with left knee pain and is lying in bed with his hip slightly flexed. He is found on imaging to have a severe slipped capital femoral epiphysis. If his leg is not manipulated for imaging, in what abnormal position is his left hip most likely to appear on an anteroposterior pelvic radiograph? QID: 5755 Type & Select Correct Answer 1 Internal rotation 9% (214/2347) 2 External rotation 84% (1965/2347) 3 Extension 1% (14/2347) 4 Abduction 3% (70/2347) 5 Adduction 3% (59/2347) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.215) A 12-year-old male previously presented with 4 days of left groin pain and inability to bear weight. Radiographs taken preoperatively, 1 week and 8 months postoperatively are seen in Figures A through C. What complication has occurred? QID: 4850 FIGURES: A B C Type & Select Correct Answer 1 Hardware migration 1% (42/3438) 2 Secondary loss of fixation 3% (98/3438) 3 Slip progression 4% (154/3438) 4 Avascular necrosis 84% (2891/3438) 5 Chondrolysis 6% (201/3438) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.240) A 12-year-old mildly overweight female presents with complaints of left hip pain. She is not dependent on crutches for ambulation. Physical examination reveals external rotation of the extremity with hip flexion. Her parents indicate that outside radiographs were interpreted to be normal. They present an MRI of the pelvis, as shown in Figures A and B. What is next best step in management? QID: 4600 FIGURES: A B Type & Select Correct Answer 1 Observation 1% (54/3666) 2 Arthroscopic labral repair 0% (14/3666) 3 In situ screw fixation 90% (3290/3666) 4 Closed reduction and percutaneous pinning 7% (268/3666) 5 Debridement of CAM impingement femoral lesion 0% (18/3666) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ12.259) A 13-year-old male presents with left hip pain and an inability to ambulate. He does not have a history of kidney disease. The initial radiograph is shown in Figure A. Which of the following zones of the growth plate (Figures B-F, all the same magnification) is most commonly involved in this condition? QID: 4619 FIGURES: A B C D E F Type & Select Correct Answer 1 Figure B 2% (97/4639) 2 Figure C 16% (725/4639) 3 Figure D 66% (3071/4639) 4 Figure E 13% (585/4639) 5 Figure F 2% (105/4639) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ11.127) A 12-year-old girl presents with groin pain six months after treatment of a slipped capital femoral epiphysis. Preoperative radiographs are seen in Figure A, radiographs six months after in situ fixation are seen in Figure B. Which of the following is associated with the radiographic abnormality seen in Figure B? QID: 3550 FIGURES: A B Type & Select Correct Answer 1 Lack of reduction prior to fixation 10% (255/2631) 2 Single screw fixation 9% (227/2631) 3 Female sex 2% (62/2631) 4 Inability to bear weight preoperatively 72% (1894/2631) 5 Obesity 7% (180/2631) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ11.81) An 11-year-old obese male presents with a slipped capital femoral epiphysis. Which of the following figures accurately represents the method used to determine the radiographic severity of the epiphyseal slip and help guide treatment? QID: 3504 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A 82% (3589/4364) 2 Figure B 14% (631/4364) 3 Figure C 1% (54/4364) 4 Figure D 1% (28/4364) 5 Figure E 1% (36/4364) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ10.66) A 13-year-old boy complains of a 3-month history of left knee, thigh and groin pain. His pain has significantly worsened over the past week. He denies pain in the right leg. Radiographs are taken and shown in Figures A and B. The history and physical do not reveal any findings concerning for an endocrine disorder. What is the preferred method of treatment? QID: 3153 FIGURES: A B Type & Select Correct Answer 1 Subtrochanteric valgus, extension, and external rotational osteotomy 1% (25/3088) 2 Non weight bearing on the left side for 6 weeks. 1% (46/3088) 3 Bilateral in situ single screw insertion across the proximal femoral physis 8% (261/3088) 4 In situ single screw insertion across the left proximal femoral physis only 88% (2711/3088) 5 Varus derotational osteotomy of the proximal femur 1% (31/3088) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.75) A 10-year-old female with right hip pain presents with the radiographs in Figure A. She has a past medical history of hypothyroidism. She undergoes in-situ screw fixation of her right hip with no intra-operative complications. Which of the following problems is most likely to occur in this scenario? QID: 736 FIGURES: A Type & Select Correct Answer 1 Chondrolysis 2% (51/3076) 2 Ostenecrosis 6% (192/3076) 3 Septic hip 0% (5/3076) 4 Ipsilateral knee pain 2% (53/3076) 5 SCFE on contralateral hip 90% (2762/3076) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.86) Figures 39a and 39b show the current radiographs of an 8-year-old girl who has had pain in the left thigh for the past 3 months. She was recently diagnosed with hypothyroidism and started treatment 1 week ago. Examination reveals a mild abductor deficiency limp on the left side. She lacks 30 degrees internal rotation on the left hip compared with the right hip. Management should consist of QID: 6146 FIGURES: A B Type & Select Correct Answer 1 abductor muscle strengthening. 1% (5/594) 2 a left 1-½ hip spica cast. 1% (6/594) 3 closed reduction and pinning of the left hip. 16% (94/594) 4 symptomatic treatment with crutch walking and nonsteroidal anti-inflammatory drugs. 1% (8/594) 5 in situ pinning of both hips. 81% (479/594) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.45) A 12-year-old boy reports limping and chronic knee pain that is now inhibiting his ability to participate in sports. Clinical examination and radiographs of the knee are normal. Additional evaluation should include QID: 6105 Type & Select Correct Answer 1 mechanical alignment radiographs. 2% (9/565) 2 stress radiographs of the knee. 2% (9/565) 3 comparison radiographs of both knees. 2% (11/565) 4 an erythrocyte sedimentation rate and a C-reactive protein. 2% (10/565) 5 examination of the hip. 92% (521/565) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.27) Of the following clinical situations, which is most likely to lead to osteonecrosis associated with a slipped capital femoral epiphysis (SCFE)? QID: 6087 Type & Select Correct Answer 1 A girl younger than age 15 years 0% (2/523) 2 A boy younger than age 15 years 0% (2/523) 3 An unstable SCFE 95% (498/523) 4 A stable SCFE 0% (2/523) 5 A stable SCFE associated with morbid obesity 3% (17/523) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ07.187) Which of the following treatment techniques decreases the risk of osteonecrosis in patients with unstable slipped femoral capital epiphysis (SCFE)? QID: 848 Type & Select Correct Answer 1 Open reduction and pinning with multiple cannulated screws in an inverted triangle configuration 5% (63/1256) 2 Closed reduction and pinning with multiple cannulated screws in an inverted triangle configuration 4% (53/1256) 3 Closed reduction and pinning with a single cannulated screw 8% (98/1256) 4 In situ percutaneous pinning with multiple cannulated screws in an inverted triangle configuration 9% (115/1256) 5 In situ percutaneous pinning with a single cannulated screw 73% (918/1256) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ07.2) Southwick angle (epiphyseal-shaft angle) serves what purpose in the evaluation of a slipped capital femoral epiphysis (SCFE)? QID: 663 Type & Select Correct Answer 1 Determine prognosis for AVN 5% (116/2229) 2 Determine the severity of the slip 87% (1934/2229) 3 Determine the presence or absence of a slip 7% (149/2229) 4 Determine the etiology of a slip 0% (9/2229) 5 Determine the chronicity of the slip 0% (9/2229) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ06.183) Hypothyroidism is most commonly associated with which of the following pediatric conditions? QID: 369 Type & Select Correct Answer 1 Legg Calve Perthes 3% (57/1895) 2 Slipped capital femoral epiphysis 88% (1671/1895) 3 Toxic synovitis 1% (12/1895) 4 Achondroplasia 3% (61/1895) 5 Rickets 4% (79/1895) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ05.60) An 11-year-old girl with hypothyroidism and obesity presents with groin pain and the inability to ambulate. Her radiograph is shown in Figure A. What is the most appropriate treatment? QID: 946 FIGURES: A Type & Select Correct Answer 1 Toe-touch weightbearing for 3 weeks 0% (4/1852) 2 Hip spica cast and non-weight bearing for 4 weeks 1% (13/1852) 3 In situ pinning of the right hip 15% (287/1852) 4 Open reduction and pinning of the right hip 3% (54/1852) 5 In situ pinning of both hips 80% (1481/1852) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ05.125) A 13-year-old Polynesian boy presents with left groin pain and inability to place weight on the left leg. His radiographs are shown in Figures A and B. All of the following are true regarding this condition EXCEPT: QID: 1011 FIGURES: A B Type & Select Correct Answer 1 The left hip is more commonly involved 21% (323/1564) 2 Forceful manipulation is not indicated because it is associated with an increased risk of complications 4% (56/1564) 3 Associated with decreased femoral anteversion and decreased femoral neck-shaft angle 23% (353/1564) 4 Pain is localized to the knee more often than the hip on initial presentation 48% (758/1564) 5 Males are more commonly affected than females 4% (68/1564) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ05.162) A 14-year-old boy presents with left groin and knee pain for 3 weeks. He is now unable to place weight on the left lower extremity, even with the assistance of crutches. AP pelvis radiograph is shown in Figure A. He is treated with surgical intervention and post-operative radiographs are shown in Figures B and C. What is the most common limb length and rotational profile found as a sequelae of this condition? QID: 1048 FIGURES: A B C Type & Select Correct Answer 1 Limb shortening, decreased hip flexion and decreased hip internal rotation 80% (1260/1568) 2 Limb lengthening, increased hip flexion, and increased hip internal rotation 1% (15/1568) 3 Limb lengthening, decreased hip flexion, and decreased hip external rotation 2% (38/1568) 4 Limb shortening, decreased hip flexion, and increased hip internal rotation 7% (114/1568) 5 Limb shortening, increased hip flexion, and decreased hip internal rotation 9% (134/1568) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ04PE.46) Figure A is the radiograph of a 10-year-old girl who sustained a left hip injury while playing soccer. She reports the inability to bear weight on the left lower extremity. Figures B and C are the 1-week and 8-week postoperative radiographs, respectively. Which of the following is considered a risk factor for developing the complication seen in Figure C? QID: 2231 FIGURES: A B C Type & Select Correct Answer 1 Hardware placement in the posterosuperior femoral neck 50% (950/1890) 2 Use of cannulated screws 13% (239/1890) 3 Having <5 screw threads engaged in the epiphysis 28% (537/1890) 4 Not attempting a forceful reduction maneuver 2% (33/1890) 5 Performing a capsulotomy 6% (119/1890) L 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ04.67) A 14-year-old female presents with a history of an undiagnosed left slipped capital femoral epiphysis 3 years ago. She has 2 years of activity-related left hip pain and pain with prolonged sitting. On physical examination she has restricted hip flexion motion, an external rotation deformity, and obligatory external rotation upon hip flexion manuevering. Radiographs are shown in Figures A and B. Which of the following osteotomies is MOST appropriate? QID: 1172 FIGURES: A B Type & Select Correct Answer 1 Medial displacement Chiari salvage osteotomy 1% (12/1340) 2 Proximal femoral varus osteotomy 4% (59/1340) 3 Flexion, internal rotation, and valgus-producing proximal femoral osteotomy (Imhauser osteotomy) 70% (941/1340) 4 Bernese periacetabular osteotomy with extension, external rotation, and valgus-producing femoral osteotomy 6% (85/1340) 5 Valgus-producing intertrochanteric proximal femoral osteotomy (Pauwel osteotomy) 17% (233/1340) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ04.83) A right hip of an 8-year-old patient is modeled in Figure A. Which of the following vessels gives the greatest blood supply to the femoral head? QID: 1188 FIGURES: A Type & Select Correct Answer 1 1 1% (20/1538) 2 2 1% (11/1538) 3 3 83% (1271/1538) 4 4 12% (179/1538) 5 5 3% (47/1538) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ04.165) A 14-year-old overweight boy complains of vague left knee pain which worsens with activity. He has an antalgic gait and increased external rotation of his foot progression angle compared to the contralateral side. Knee radiographs, including stress views, are negative. What is the next step in management? QID: 1270 Type & Select Correct Answer 1 Knee MRI 2% (26/1431) 2 Knee CT 0% (7/1431) 3 AP pelvis and frog-lateral views 96% (1367/1431) 4 Diagnostic knee arthroscopy 0% (5/1431) 5 Hip MRI 1% (11/1431) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
All Videos (7) Podcasts (3) Login to View Community Videos Login to View Community Videos Unstable SCFE closed reduction Craig Louer Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) B 2/15/2022 143 views 0.0 (0) 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope Slipped Capital Femoral Epiphysis: Reduce - Francois Lalonde, MD Francois Lalonde Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) A 3/3/2021 1454 views 4.3 (3) 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope Slipped Capital Femoral Epiphysis: Fix - Verena M. Schreiber, MD Verena M. Schreiber Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) A 3/3/2021 924 views 3.5 (2) Pediatrics ⎜ Slipped Capital Femoral Epiphysis (ft. Dr. Rachel Goldstein) Team Orthobullets (AF) Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) Listen Now 26:55 min 10/18/2019 216 plays 0.0 (0) Question Session⎪Slipped Capital Femoral Epiphysis (SCFE) Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) Listen Now 20:2 min 4/4/2020 487 plays 5.0 (2) Pediatrics | Slipped Capital Femoral Epiphysis (SCFE) Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) Listen Now 33:41 min 4/9/2020 1639 plays 5.0 (1) See More See Less
Nationwide Children's Hospital Slipped Capital Femoral Epiphysis in 14M (C101997) Craig Smith Devon Myers Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) A 2/11/2022 8857 47 9 University of Utah Pediatric Orthopaedic Fellowship Slipped Capital Femoral Epiphysis in a 12F (C101570) Stephanie M. Holmes Aaron Wey Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) A 8/21/2020 12815 47 9 Bilateral Genu valgum with bilateral slipped capital femoral epiphysis (C1887) Kanagaratnam Kandeepan Pediatrics - Slipped Capital Femoral Epiphysis (SCFE) E 4/24/2014 216 0 6