Value of the False-Profile View to Identify Screw-Tip Position During Treatment of Slipped Capital Femoral Epiphysis
A Case Report
Scott E. Van Valin, MD; Dennis R. Wenger, MD

Slipped capital femoral epiphysis occurs with an incidence of up to ten per 100,000 population, depending on the race of the patient and the geographic region studied1. The treatment for slipped capital femoral epiphysis has evolved with time; currently, orthopaedists in both general and subspecialty practice most commonly use percutaneous in situ screw stabilization to treat the disorder2,3. Because of the posterior displacement of the epiphysis and retroversion of the femoral neck, the classic “laterally based” starting point for insertion of screws (as would be used for operative treatment of femoral neck fractures in adults) needs to be located more anteriorly and superiorly on the lateral-proximal aspect of the femur3,4.

Fig. 1

Initial frog-leg lateral radiograph of left hip, demonstrating a slipped capital femoral epiphysis. This ten-year-old girl had moderate pain and could walk; thus, the slip was classified as stable.

The distortion in femoral head-neck anatomy with slipped capital femoral epiphysis can make radiographic visualization of the articular surface (to determine joint encroachment or penetration by the pin or screw) difficult. Unrecognized joint penetration with a screw can lead to chondrolysis5-7. Over the last twenty-five years, knowledge of the risk for joint penetration, as well as the use of high-quality image intensifiers, has reduced but not eliminated this risk8-12.

We present the case of a patient who was referred to our facility as a result of hip pain after screw placement for slipped capital femoral epiphysis, and we demonstrate the use of an easily obtainable radiograph that can help to identify the position of the screw tip in a patient who has unexplained hip pain following screw stabilization for slipped capital femoral epiphysis. Our patient and her family were informed that data concerning …

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