Emergency Cases Northwest Group

063 Hip Hip Hooray!

Situation

Child’s hip pain was a SUFE

Background

An 11 year old boy went to his GP with hip pain, who did an X-ray. The report showed left sided SUFE [slipped upper femoral epiphysis]. The child was then sent to the ED.

Assessment

Assessing a child’s hip X-ray:

The line of Klein should run from the upper femoral neck and intersect the edge of the epiphysis like this:

https://www.tamingthesru.com/blog/diagnostics/pelvic-xrays

If it doesn’t then there is a SUFE, like this:

https://en.wikipedia.org/wiki/Trethowan%27s_sign

In this case, the SUFE was much more apparent on the lateral frog’s leg view and not so apparent on the first AP view.

Recommendation

If you suspect a chronic SUFE [non-acute pain, weight bearing] do frogs leg views if the AP X-ray is normal.

If you suspect an acute SUFE [acute pain, non weight bearing] don’t do frogs leg views as it could damage the femoral blood supply.



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Emergency Cases Northwest Group