...
Interesting Rare Case Pictures
Bilateral hip pain with hypogonadism
Raju Vaishya a
, Vipul Vijay b
, Abhishek Vaish c
a
Sr...
fixation with pins or screws. In delayed presentation and
severe slippage, an open reduction of the physis and fixa-
tion or...
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Bilateral hip pain with hypogonadism

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A 16-year-old boy presented with bilateral groin pain and limp (R > L) for 3 months. He was obese (BMI:31.4) with features of hypogonadism (Fig. 1). Right hip had fixed external rotation deformity and movements were restricted. Plain radiographs revealed bilateral Slipped Capital Upper Femoral Epiphysis (SCUFE): Grade III on right and Grade I on left side (Fig. 2). Serum Vitamin D level was low (12 ng/ml). He was treated by in situ fixation of the slippage of both hips, by 2 cancellous screws (Fig. 3) followed by immediate relief of pain.

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Transcript of "Bilateral hip pain with hypogonadism"

  1. 1.                                                                                                                                        Bilater        ral hip paiin with hy      ypogonaddism
  2. 2. Interesting Rare Case Pictures Bilateral hip pain with hypogonadism Raju Vaishya a , Vipul Vijay b , Abhishek Vaish c a Sr Consultant, Department of Orthopedics, Indraprastha Apollo Hospitals, Sarita Vihar, India b Associate Consultant, Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, India c PG student, Department of Orthopaedics, Sancheti Institute of Orthopaedics, Pune, India a r t i c l e i n f o Article history: Received 1 April 2014 Accepted 2 April 2014 Available online 3 June 2014 A 16-year-old boy presented with bilateral groin pain and limp (R > L) for 3 months. He was obese (BMI:31.4) with fea- tures of hypogonadism (Fig. 1). Right hip had fixed external rotation deformity and movements were restricted. Plain radiographs revealed bilateral Slipped Capital Upper Femoral Epiphysis (SCUFE): Grade III on right and Grade I on left side (Fig. 2). Serum Vitamin D level was low (12 ng/ml). He was treated by in situ fixation of the slippage of both hips, by 2 cancellous screws (Fig. 3) followed by immediate relief of pain. The common presentation of SCUFE include pain, limp, and decreased range of motion of the hip.1 It is often found in peripubertal age (boys > girls) and bilateral involvement is common. The precise aetiology is not known. Conditions which weaken the epiphysis including endocrinal and metabolic disorders (e.g. obesity, hypothyroidism, pan hy- popituitarism and Vitamin D deficiency) are commonly associated with it.2 SCUFE occurs due to disruption through the growth plate, resulting in slippage of epiphysis over the neck of femur. Normally, a line passing from the superior border of the neck of femur (Klein’s line) transects the femoral head but in SCUFE the capital physis lies inferior to the line due to the slip (Trethowan’s sign), on a plain radiograph. Early treatment of the slips is by in situ Fig. 1 e Inguinal region showing features of hypogonadism. E-mail address: raju.vaishya@gmail.com (R. Vaishya). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/apme a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 1 4 5 e1 4 6 http://dx.doi.org/10.1016/j.apme.2014.04.002 0976-0016/Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
  3. 3. fixation with pins or screws. In delayed presentation and severe slippage, an open reduction of the physis and fixa- tion or a subcapital or intertrochanteric osteotomy may be required.3 Slipped capital upper femoral epiphysis (SCUFE) is com- mon in young adolescent (males females) and usually present with pain and limp. SCUFE is commonly associated with hypogonadism, endocrinal abnormalities and vitamin D deficiency. Surgical fixation of the SCUFE (in situ) is the treatment of choice. Conflicts of interest All authors have none to declare. r e f e r e n c e s 1. Aronsson DD, Loder RT, Breur GJ, et al. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg. 2006;14(12):666e679. 2. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. Bone Joint J. 2013 Jun;95-B(6):851e854. 3. Peck K, Herrera-Soto J. Slipped capital femoral epiphysis: what’s new? Orthop Clin North Am. 2014 Jan;45(1):77e86. Fig. 2 e AP radiograph of the hips showing slipped capital upper femoral epiphyses (R L). Fig. 3 e APradiographof bothhipsshowing fixationofSCUFE (in situ) by 2 cannulated cancellous screws on each side. a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 1 4 5 e1 4 6146
  4. 4. Apollohospitals:http://www.apollohospitals.com/ Twitter:https://twitter.com/HospitalsApollo Youtube:http://www.youtube.com/apollohospitalsindia Facebook:http://www.facebook.com/TheApolloHospitals Slideshare:http://www.slideshare.net/Apollo_Hospitals Linkedin:http://www.linkedin.com/company/apollo-hospitals Blog:Blog:http://www.letstalkhealth.in/

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