Pelvis Case #5

H&P11 year old boy is

brought in by his mother for left hip and knee pain. The boy says the pain has been going on for over a week and its causing him to limp. They deny fevers or trauma.

PEAfebrile. VSS.Gen: Well appearing.

Non toxic.Extrem: Fairly

benign exam. Has some pain with internal rotation of left hip

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SCFE

The most important part of ED management is not missing the diagnosis. Missed SCFE can lead to avascular necrosis

Note that SCFE can present as knee pain that is referred from the hip so complaints of knee pain should prompt evaluations of the hip

Orthopedic consultation should be considered emergent. SCFE is ultimately treated with ORIF.

ED Management

Use Klein line to eval for scfe. The line should pass through the femoral head

Loder, R. “Slipped Capital Femoral Epiphysis”. American Family Physician. 1999.

Kevin, Walter et al. “Slipped Capital Femoral Epiphysis”. Emedicine.com. 12/2009.

Tininalli, J et al. “Emergency Medicine: A Comprehensive Study Guide”. 6th ed. 2003

Wheeless, C. “Slipped Capital Femoral Epiphysis”. Wheelessonline.com. 5/2011

References