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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