Imaging description

A 13-year-old boy presented with left groin pain. A radiograph of the pelvis was obtained and demonstrated widening and irregularity of the physis of the left proximal femur associated with demineralization of the femoral head. Klein’s line, a line drawn along the tangent of the lateral margin of the femoral neck, did not intersect the left femoral head (Fig. 85.1a). Findings were consistent with slipped capital femoral epiphysis (SCFE). In addition, a “metaphyseal blush,” an area of increased density in the proximal metaphysis was seen, representing bony healing (Fig. 85.1c). The affected left femoral epiphysis appeared smaller compared to the right side due to the posterior slippage (Fig. 85.1c). The Southwick method for evaluating the head-shaft angle may be helpful for preoperative planning (Fig. 85.1b). Figure 85.2 shows a follow-up radiograph in a different 12-year-old boy, demonstrating surgical pinning of a left-sided SCFE.

An MRI of a 10-year-old girl with SCFE shows high T2 signal within the physis and posteromedial slippage of the right femoral capital epiphysis. There is also an associated joint effusion and bone marrow edema (Fig. 85.3).