Valgus slipped capital femoral epiphysis

Abstract

Valgus slips of the epiphysis are rare, making radiological diagnosis difficult. A high degree of clinical suspicion is required to diagnose the condition. The patient was a 13-year, 7-month-old girl who had been suffering from pain in the left thigh for ten days. She had a limp and a positive Trendelenburg sign. Menstrual function had started when she was 12 years and 10 months old. Pain occurred with getting up from a chair. Hip radiographs revealed symmetrical, bilateral caput valgum, which was a potential cause of confusion given the valgus displacement of the proximal femoral epiphysis. Axial view showed an almost imperceptible posterior slip. The patient was diagnosed as having a valgus slipped capital femoral epiphysis (SCFE). Surgical treatment was performed using in-situ fixation with a cannulated, fully threaded percutaneous screw placed through the external cortex of the femoral neck. Non-weight-bearing for six weeks was prescribed. Although a medial approach is usually used for screw insertion using a more medial entry-point, preventing neurovascular risks, in-situ fixation (through a lateral approach) was performed more safely and distally. This was done through the outer cortex of the femoral neck (and centered in the axial view), to achieve fixation of the femoral head in the center of the femoral neck and head.

Figure 1

A) Anteroposterior roentgenogram of both hips. Horizontal proximal physis can be seen of both hips with idiopathic caput valgum. B) Bilateral axial view showing valgus slipped proximal femoral epiphysis of the left hip.

Figure 2

More detailed view on A) AP view and B) axial view. Note the difference in Klein's line.

Figure 3

A) Four years after the surgery. Anteroposterior view after “in situ” fixation. Due to the minimal space available, the screw threads pass through the outer cortex of the femoral neck. B) Axial view showing the screw centered in the neck of the proximal femur. Physeal fusion can be seen in both projections.