Almedaifer Sulaiman F, AlShehri Abdullah J, Alhussainan Thamer S
Orthopedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU.
Cureus. 2018 Nov 15;10(11):e3598. doi: 10.7759/cureus.3598.
Valgus slipped capital femoral epiphysis (SCFE) is very infrequent, and it is characterized by a superolateral displacement of the epiphysis on the metaphysis. To date, less than 100 cases of valgus SCFE have been described in the literature. Bilaterality of valgus SCFE is extremely rare, and it presents management challenges to the treating orthopedic surgeons. Herein, we report the case of an 11-year-old Saudi Arabian girl presented to clinic with a one-year history of bilateral hip pain and limping. Past medical history was negative for endocrinopathies, hemoglobinopathies, bone disorders, trauma or radiation therapy to the pelvis. On physical examination, the patient looked tall and obese. On clinical examination, the patient showed a waddling gait and an external rotation on walking. A frog-leg lateral radiograph showed bilateral SCFE with a valgus deformity. The right and left femoral neck-shaft angles measured 154.3 and 148.2 degrees, respectively. Computed tomography (CT) scan suggested a moderate bilateral posterior slippage of femoral heads; the right and left femoral head-neck angles measured 60 and 52 degrees, respectively. A final diagnosis of bilateral valgus SCFE was established. Consequently, the patient underwent bilateral percutaneous in situ pinning with single cannulated screws. Postoperatively, the patient made an uneventful recovery. At one-year follow-up, hip radiograph showed bilateral atypical narrowing of the joint space and suspected chondrolysis and the physis of both proximal femoral heads were fused. On the right side, the fixating screw was penetrating into the articular surface of the femoral head with some osteoarthritic changes. Considering the patient's worsening situation, it was decided to perform a revisional surgery. The revisional surgery included the removal of bilateral screws and administration of local steroids and analgesics for pain control. Post-revisional surgery at three months, though the patient was limping with a pelvic tilt, she was able to ambulate with the aid of axillary crutches.
外翻型股骨头骨骺滑脱（SCFE）非常罕见，其特征是骨骺在干骺端向外侧上方移位。迄今为止，文献中报道的外翻型SCFE病例不足100例。外翻型SCFE双侧发病极为罕见，给骨科治疗医生带来了管理挑战。在此，我们报告一例11岁沙特阿拉伯女孩的病例，该女孩因双侧髋关节疼痛和跛行一年就诊。既往病史显示无内分泌疾病、血红蛋白病、骨骼疾病、创伤或骨盆放疗史。体格检查时，患者看起来身材高大且肥胖。临床检查发现患者步态蹒跚，行走时伴有外旋。蛙式侧位X线片显示双侧SCFE伴外翻畸形。右侧和左侧股骨颈干角分别为154.3度和148.2度。计算机断层扫描（CT）显示双侧股骨头有中度向后移位；右侧和左侧股骨头颈角分别为60度和52度。最终确诊为双侧外翻型SCFE。因此，患者接受了双侧经皮原位单枚空心螺钉内固定术。术后，患者恢复顺利。随访一年时，髋关节X线片显示双侧关节间隙非典型变窄，疑似软骨溶解，双侧近端股骨头骨骺融合。右侧，固定螺钉穿透股骨头关节面，伴有一些骨关节炎改变。考虑到患者病情恶化，决定进行翻修手术。翻修手术包括取出双侧螺钉，并给予局部类固醇和镇痛药以控制疼痛。翻修手术后三个月，尽管患者仍跛行且伴有骨盆倾斜，但她能够借助腋拐行走。
