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.
Hip Pain in an Adolescent
X-ray shows Slipped Epiphysis
Normal Pelvis showing
Hip Joints