Femoral Head-Neck Translation Ratio Is a Measurement of the True Deformity of Slipped Capital Femoral Epiphysis.

Panagiotis V Samelis,Olga Savvidou,Flourentzos Georgiou,Christos Loukas,Andreas Mavrogenis,Eleni P Sameli,Evangelos Triantafyllou,Panagiotis Koulouvaris,Zoi Fryda,Hara Komari

doi:10.7759/cureus.14133

Abstract

A new method to quantify proximal femoral head-neck deformity in slipped capital femoral epiphysis (SCFE) is presented. In SCFE the femoral head slips posteriorly and inferiorly relative to the femoral neck. The distance of the femoral head center from the femoral neck axis (center-axis distance, CAD) represents the severity of the post-slip deformity. CAD is calculated on the anteroposterior and the frog-lateral pelvis views. It is shown that CAD is only a function of the femoral head-neck offset difference on both sides of the femoral neck. The percentage of CAD relative to the diameter of femoral neck is the femoral head-neck translation ratio (FHNTR) on the respective x-ray projection. Measurements on radiographs of 37 patients with history of unilateral SCFE were performed. The asymptomatic contralateral hips were used as controls. On the anteroposterior pelvis view, mean FHNTR was -12.2% and -4.3% for the affected and asymptomatic contralateral hips, respectively (paired t-test, p < .01), indicating inferior translation of the femoral head relative to the femoral neck. On the frog-lateral view, mean FHNTR was -21.1% and -6.5% for the affected and the contralateral hips, respectively (paired t-test, p < .01), indicating posterior translation of the femoral head relative to the femoral neck. There is a moderate inverse correlation between FHNTR on the frog-lateral pelvis view and Southwick's slip angle (Pearson correlation coefficient r = -0.679, p < .001). FHNTR on two radiological planes (anteroposterior and frog-lateral) is a simple measurement of the posteroinferior translation of the femoral head relative to the femoral neck in SCFE. It is a measurement of the true deformity of the proximal femur in SCFE. Calculation of FHNTR may be applicable to classify SCFE, to monitor femoral head-neck remodeling after slip stabilization, to describe the femoral head-neck relation in healthy individuals, and to monitor femoral head-neck changes secondary to other hip pathology, such as Perthes disease or developmental dysplasia of the hip.

Highlights

Slipped capital femoral epiphysis (SCFE) is the most frequent non-traumatic cause of a painful limp in the adolescent
In slipped capital femoral epiphysis (SCFE), gradual external rotation and proximal migration of the femoral neck relative to the stably seated in the acetabulum capital femoral epiphysis result in slippage of the capital femoral epiphysis in two directions relative to the femoral neck: posteriorly and inferiorly [2,3,4]
On the FL view, mean femoral head-neck translation ratio (FHNTR) was -21.1% (SD = 10.5%) for the SCFE and -6.5% (SD = 4.1%) for the asymptomatic contralateral hips, respectively (p < 0.01)

Summary

Introduction

Slipped capital femoral epiphysis (SCFE) is the most frequent non-traumatic cause of a painful limp in the adolescent. It affects predominantly the left hip of boys [1]. Half of the cases present the adiposogenital phenotype (obesity in combination with hypogonadism) indicating underlying endocrine disorder [1]. Prompt diagnosis and treatment are the only way to prevent slip exacerbation and to avoid femoroacetabular impingement (FAI) and early-onset hip osteoarthritis [1]. Diagnosis is not always easy, especially in the presence of subtle symptoms or in case of lack of clinical suspicion by the examiner [5]. Diagnosis of SCFE is based on plain radiographs of the hips

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