February 2017
Information for Parents with Children
A few few weeks ago I posted an article for the doctors in the Forum under Medico legal section on how a child who presented with a hip pain was misdiagnosed by the medical team which lead to a serious disability affecting that child. I thought the public should be made aware of it so that they would make sure the doctor rules out this condition if their child presented with a similar symptom. A child who is limping or complaining of pain in the groin, hip, thigh or knee must be taken seriously. Depending on the age of the child, different pathological conditions could affect the hip. In this article I write about a condition called Slipped Upper Femoral Epiphysis which may affect teenage children To understand the pathology of slipped upper femoral epiphysis you should know a little about how the hip bone develops. The upper end of the thigh bone (femoral head) together with the socket in the pelvis (acetabulum) form the ball and socket hip joint. The femoral head in a growing child is made up of 2 parts, a bony part and a growing area called the growth plate that contributes to growth of the bone. The growth plate will disappear when the the hip joint is fully formed and the bone growth ceases (between 16 to 18 years of age). Until this happens the growth plate can slip from its position in some children. If it is not treated promptly it can lead to a serious disability. Presentation: It can affect any child between the ages of 10 to 16 usually in boys. The children are often a little obese and complain of some discomfort or pain in the hip, thigh or knee. Sometimes the pain and limp follow a trivial injury. They do not have any other symptom like fever or cough. When you see the child lying flat on the back you may notice the affected leg turned out slightly. Cause for Slipped Upper Femoral Epiphysis: The exact cause is not known though it is the most common hip disorder in adolescents. One in 10000 children are affected by it. Some believe that during adolescence the hormonal changes taking place may contribute to it. Management: If SUFE is suspected an x-ray of the hip must be done urgently. Occasionally a scan may be done. The x-ray will confirm the diagnosis. Once confirmed the child will be admitted and the growth plate which is slipping will be fixed. If the slip is minimal it will be fixed in the position of slip. If there is considerable slip it will be manipulated to as near a normal position as possible and then fixed. The procedure will be done by an orthopaedic surgeon under a general anaesthetic. It is a fairly simple procedure where the growth plate is fixed by one or two screws through a tiny incision. If the condition is not recognised soon or the symptoms neglected for a period of time treatment becomes more complicated and the results are not always good. Prognosis: If treated promptly the prognosis is excellent with no residual problems. If neglected it will lead to serious complications. Complications of Neglect or Delayed Treatment: Shortening of the leg Deformity affecting the hip (Leg turned out slightly) Early onset of Osteoarthritis with chronic pain. Points to remember about Slipped Upper Femoral Epiphysis:. Occurs in adolescent boys between 10 and 16 years. Girls affected less often. Presents with pain in the Groin, hip, thigh or knee Can occur with or without trauma An x-ray of the hip must be done to rule out the condition. If treated without delay the prognosis is good K. Badrinath For detailed medical discussion on the topic in “Forum” CLICK HERE
Previous Topics Discussed on Health
Hip Pain in an Adolescent
X-ray shows Slipped Epiphysis
Slipped Epiphysis reduced to a good position and fixed
Normal Pelvis showing Hip Joints