eMedicine Specialties > Radiology > Pediatrics

Slipped Capital Femoral Epiphysis: Imaging

Author: Brent Adler, MD, Chief of Musculoskeletal Imaging, Department of Radiology, Children's Hospital
Contributor Information and Disclosures

Updated: Mar 18, 2008

Radiography

Findings

Diagnosis is made using AP pelvis and lateral frog-leg radiographs. Abduction of the femur for the frog-leg view may result in increased slippage and should be performed with caution (see Images 1-6).

On AP radiographs, close attention should be paid to the physis. Early in SCFE, the physis may widen. Increased opacity in the metaphysis, described as blanching, may occur as an early healing response, and the epiphysis may appear smaller because it is tilted dorsally.

The lateral radiograph demonstrates slippage earliest because the slippage begins with posterior displacement and progresses with medial rotation.

The Southwick method can be used by creating an axis for the femoral neck and determining whether the epiphysis is tilted (see Image 4).

An additional method is to draw a line along the lateral aspect of the femoral neck on the AP view; this line, known as the line of Klein, should intersect a portion of the femoral head.11

Degree of Confidence

Degree of confidence in radiographic findings of SCFE is high.

False Positives/Negatives

When the aforementioned constellation of findings is present, false-positive and false-negative findings do not occur.

Computed Tomography

Findings

CT is a sensitive method for measuring the degree of tilt and detecting disease, but it is rarely needed. Usually, CT is performed only at the request of the treating physician for documenting the severity of the tilt.

Magnetic Resonance Imaging

Findings

The earliest way to detect SCFE is by using MRI. With MRI, early marrow edema and slippage can be demonstrated. This is demonstrated with increased signal on T2-weighted and water-sensitive images. MRI can be considered in patients for whom the clinical suspicion of SCFE is high and in whom the radiographs appear normal. MRI can be considered for follow-up imaging of the contralateral hip.

False Positives/Negatives

Marrow edema is a nonspecific finding, and while it can indicate early bone changes in SCFE, it has numerous other causes, such as infection or even tumor. Those diagnoses are rarely considered with the proper clinical evaluation.

Ultrasonography

Findings

Ultrasonographic findings are rarely specific, and the sensitivity of sonography is unknown. Hip effusions of blood often have been reported and are suggestive of fracture.

Nuclear Imaging

Findings

The radionuclide bone scan is sometimes used during workup but prior to diagnosis. Accumulation of the bone scanning agents can be decreased after fixation and in patients with an acute slip and significant displacement. The decrease is usually limited to the epiphysis. The decreased accumulation is associated with increased incidence of chondrolysis.

More on Slipped Capital Femoral Epiphysis

Overview: Slipped Capital Femoral Epiphysis
Imaging: Slipped Capital Femoral Epiphysis
Follow-up: Slipped Capital Femoral Epiphysis
Multimedia: Slipped Capital Femoral Epiphysis
References
[ CLOSE WINDOW ]

References

  1. Ballas MT, Tytko J. Commonly Missed Orthopedic Problems page. American Academy of Family Physicians Web site. 1998. Available at: http://www.aafp.org/afp/980115ap/ballas.html. Accessed March 13, 2008. [Full Text].

  2. Boles CA, el-Khoury GY. Slipped capital femoral epiphysis. Radiographics. Jul-Aug 1997;17(4):809-23. [Medline].

  3. Murray AW, Wilson NI. Changing incidence of slipped capital femoral epiphysis: A RELATIONSHIP WITH OBESITY?. J Bone Joint Surg Br. Jan 2008;90(1):92-4. [Medline].

  4. Yildirim Y, Bautista S, Davidson RS. Chondrolysis, osteonecrosis, and slip severity in patients with subsequent contralateral slipped capital femoral epiphysis. J Bone Joint Surg Am. Mar 2008;90(3):485-92. [Medline].

  5. Lim YJ, Lam KS, Lim KB, Mahadev A, Lee EH. Management outcome and the role of manipulation in slipped capital femoral epiphysis. J Orthop Surg (Hong Kong). Dec 2007;15(3):334-8. [Medline].

  6. Odgers CJ, Dabney K. Bilateral Slipped Capital Femoral Epiphysis. 1996. Available at: http://gait.aidi.udel.edu/res695/homepage/pd_ortho/educate/clincase/scfe.htm. Accessed March 13, 2008. [Full Text].

  7. Miyanji F, Mahar A, Oka R, Pring M, Wenger D. Biomechanical comparison of fully and partially threaded screws for fixation of slipped capital femoral epiphysis. J Pediatr Orthop. Jan-Feb 2008;28(1):49-52. [Medline].

  8. Yamamoto LG. Thigh and Knee Pain in an Obese 10-Year Old. Radiology Cases in Pediatric Emergency Medicine. 1995. Available at: http://www2.hawaii.edu/medicine/pediatrics/pemxray/v2c10.html. Accessed March 13, 2008. [Full Text].

  9. Keiser V, Berlin S, Myers M, et al. Slipped Capital Femoral Epiphysis. Pediatric Imaging Teaching Files. Available at: http://www.uhrad.com/pedsarc/peds049.htm. Accessed March 13, 2008. [Full Text].

  10. Resnick D. Diagnosis of Bone and Joint Disorders. 3rd ed. Philadelphia: WB Saunders Co;1995.

  11. Gekeler J. Radiology of adolescent slipped capital femoral epiphysis: measurement of epiphyseal angles and diagnosis. Oper Orthop Traumatol. Oct 2007;19(4):329-44. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

SCFE, hip abnormality, early osteoarthritis, proximal femoral physis, Salter-Harris type 1 fracture, hip pain

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Brent Adler, MD, Chief of Musculoskeletal Imaging, Department of Radiology, Children's Hospital
Brent Adler, MD is a member of the following medical societies: American College of Radiology, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Medical Editor

Beverly P Wood, MD, MS, PhD, Professor, Departments of Radiology and Pediatrics, Division of Medical Education, Keck School of Medicine, University of Southern California
Beverly P Wood, MD, MS, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Marta Hernanz-Schulman, MD, FAAP, Professor, Radiology, Radiological Sciences, and Pediatrics, Director, Department of Pediatric Radiology, Radiologist-in-Chief, Director, Department of Diagnostic Imaging, Vanderbilt University Medical Center, Vanderbilt Children's Hospital
Marta Hernanz-Schulman, MD, FAAP is a member of the following medical societies: American Institute of Ultrasound in Medicine and American Roentgen Ray Society
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.