Normal hip xray frog leg4/23/2024 ![]() ![]() To prevent further slippage, children with suspected or diagnosed SUFE should immediately be made non–weight bearing with crutches or a wheelchair. A. Antero-posterior pelvis X-ray demonstrating abnormal Klein’s line (dotted line) and widening of the physis on the right hip (solid arrow) B. Frog-leg lateral X-ray demonstrating an increased the Southwick slip angle (solid line) Slip severity is considered mild when the angle is 50°. On a frog-leg lateral view, the Southwick slip angle can be measured between the axis of the femoral shaft and the epiphysis. On this child’s right hip, Klein’s line does not intersect the femoral head, consistent with an SUFE. On an AP X-ray, a line drawn along the superior femoral neck (Klein’s line) should intersect the superolateral portion of the femoral head (Figure 2). What is the recommended treatment for SUFE? Answer 3 What are the relevant radiographic findings? Question 4 A. Antero-posterior pelvis X-ray B. Frog-leg lateral X-ray AP pelvis and frog-leg lateral X-ray views were obtained (Figure 1).įigure 1. The patient was given crutches and advised not to weight bear on the painful hip. MRI is also useful for investigating osteomyelitis and tumours. Magnetic resonance imaging (MRI) is occasionally used to detect physeal abnormalities where there is a high index of suspicion for SUFE, but X-rays are normal. If there is clinical suspicion of a septic arthritis, serum inflammatory markers and joint ultrasonography should be ordered. Key radiographic features include displacement of the femoral epiphysis or physeal irregularity. 3 Answer 2Īn antero-posterior (AP) pelvis and frog-leg lateral X-ray should be ordered to assess for bony pathology. In the presence of infective symptoms or signs, septic arthritis should be excluded. Perthes’ disease has a similar presentation but is more prevalent in younger children. In the absence of infective symptoms, an SUFE should be suspected in any child or prepubertal adolescent with groin, thigh or knee pain and altered gait, until proven otherwise. 1 Patients with stable SUFEs may present in the primary care setting, whereas patients with unstable SUFEs typically present directly to hospital via ambulance. Spinal, abdominal and pelvic pathology can also refer pain to the hip.Īccording to the Loder classification, SUFE can be classified as stable if the patient can weight bear, with or without aids, or unstable if they are unable to weight bear at all. The most likely diagnosis is a slipped upper femoral epiphysis (SUFE), with other possibilities including Perthes’ disease, septic arthritis, peri-articular osteomyelitis, transient synovitis, tumours and occult fractures. What investigations are indicated? Answer 1 ![]() What is the differential diagnosis? Question 2 His hip was irritable with passive range of motion, particularly in flexion and internal rotation. He had an antalgic gait and held his right lower limb in an externally rotated posture. ![]() He was on the 50th centile for height and the 90th centile for weight. On examination, he had normal vital signs and was afebrile. His developmental history was unremarkable. He was otherwise healthy, had no history of recent travel, and was fully immunised. He could not recall an inciting event, had no history of hip pathology, and had not experienced similar symptoms previously. This occurred on the background of four weeks of mild, intermittent pain in the same region. A boy aged 11 years presented to his general practitioner with a two-day history of severe right groin pain and difficulty weight bearing. ![]()
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