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CASE REPORT Table of Contents   
Year : 2005  |  Volume : 39  |  Issue : 4  |  Page : 260-261
Proximal femoral epiphysiolysis in an adult-A case report


Department of Orthopaedics & Traumatology, Madras Medical College & Research Institute,Govt. General Hospital, Chennai, India

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How to cite this article:
Pasupathy B, Natarajan M, Sivaseelam A, Selvaraj R, Sudarshan I S. Proximal femoral epiphysiolysis in an adult-A case report. Indian J Orthop 2005;39:260-1

How to cite this URL:
Pasupathy B, Natarajan M, Sivaseelam A, Selvaraj R, Sudarshan I S. Proximal femoral epiphysiolysis in an adult-A case report. Indian J Orthop [serial online] 2005 [cited 2020 Jan 21];39:260-1. Available from: http://www.ijoonline.com/text.asp?2005/39/4/260/36629

   Introduction Top


Displacement of the proximal femoral epiphysis (Epiphysiolysis) occurs in children going through the pubertal growth spurt, due to the inability of the immature proximal femoral physis to bear the shear stress. This is common in adolescent age between 10 years to 16 years with male preponderance [1] . The left hip is more commonly affected but bilateral presentation can occur. It is occasionally seen in adult. In adult though the aetiology is obscure, the presenting patients may have endocrine disorders viz.hypothyroidism, hypopituitarism and hypogonadism [2],[3],[4] . Progressive slip can be managed by prevention of further slip and correction of deformity [5] . Deformity correction is done by various osteotomies around the proximal femur. Further slip is prevented by fixing the epiphysis and promoting union using various devices like dynamic hip screw, angled plate, cancellous screws and smooth pins [3],[5]


   Case Report Top


An obese 22 years old male patient presented with progressively worsening limp on the right lower limb for the previous six month. On evaluation he was diagnosed as having slipped capital femoral epiphysis [Figure - 1]. He had limitation in hip abduction and internal rotation and true shortening of 2cm on right supra trochanteric region. General evaluation showed features of hypothyroidism, which was proven by hormonal assay. Radiological evaluation showed persistent open physis on right side with proximal femoral epiphyseal slip. The epiphysis on the left side was found to, be fused, there was no slip on left hip [Figure - 1]. Presence of open iliac apophysis was suggestive of the bone age lagging behind the chronological age.

He was treated with bed rest and skin traction. He was started on thyroxine and attained euthyroid level. The patient was treated with Southwicks biplane subtrochanteric osteotomy. The osteotomy and the reduced slip were stabilized with dynamic hip screw [Figure - 2]. The DHS was used for the purpose of transfixing the epiphysis and achieving epiphysiodesis. The patient was allowed for non-weight bearing hip and knee mobilization for six weeks. Then partial weight bearing and crutch walking allowed. Radiological evidence of satisfactory union was noticed at 24 weeks and full weight bearing allowed.

At 18 months follow up patient was totally symptom free. He attained normal limb length and improved range of hip movements in abduction and internal rotation. Radio logically there was good consolidation at osteotomy site and fusion of the physis [Figure - 3]. There was no evidence of arthritis or osteonecrosis.


   Discussion Top


The proximal femoral epiphysiolysis in adult is commonly associated with endocrinal disturbances. According to Loder et al, the proportions were: Hypothyroidism-40%, Growth Hormone deficiency-25% and others-35% in that order [6] . The Hypothyroid patients usually had the endocrine diagnosis made at presentation of first SCFE. The Growth Hormone deficient patients usually had the endocrine diagnosis made before that of the SCFE. Hypothyroid patients can develop further slip during hormonal supplementation. The condition is also associated with excess growth hormone and deficient sex hormone as seen in Gigantism [7] . SCFE has been reported in an adult, whom on evaluation revealed primary hypothyroidism. Hormonal therapy and definitive surgical management of SCFE is indicated in adults [5] . Southwicks biplane osteotomy [3],[5],[8] , though associated with 15% incidences of chondrolysis, doesn't cause avascular necrosis of the head when compared to other osteotomies .

High index of suspicion towards endocrinal disorder is essential in successful treatment of an adult SCFE. Hormonal therapy with surgical management of the slip gives commendable result. Single fixation device attempting correction of deformity and promote epiphyseal closure is ideal for this condition. This case is being presented for its rarity in adult and its management.

 
   References Top

1.Mercer's Orthopaedic Surgery,9 th edition London ; Edward Arnold 2004;377  Back to cited text no. 1    
2. Apley's system of Orthopaedics and Fractures, 8th edition; 2001; 426­8.  Back to cited text no. 2    
3. Napiontek M, Koczewski P. Treatment of slipped capital femoral epi­physis with one-time-head-neck transfixation and subtrochanteric cor­rective osteotomy. Chir Narzadow Ruchu Orthop Pol.1996; 61(3)275­81.  Back to cited text no. 3    
4. Al-Aswad BI, Weinger JM, Scheinder AB. Slipped Capital Femoral Epiphysis in a 35-year old man; Clin Orthop.1978;134:131-4.  Back to cited text no. 4    
5. Salvati EA, Ronbinson JH, O'Down TJ. Southwick osteotomy for severe chronic SCFE; result and complications: J Bone Joint Surg (Am). 62:561-70.  Back to cited text no. 5    
6. Loder RT, Wittenberg B, De Silva G. Slipped capital femoral epiphy­sis associated with endocrine disorders. J Paediatr Orthop. 1995; 15(3):349-56.  Back to cited text no. 6    
7. Unnikrishnan AG, Agarwal NK. Endocrinopathies in SCFE. J Assoc Phys I. 2003; 51:826-7.  Back to cited text no. 7    
8. Ohmori M, Harada K, Sugimoto K, Kobayashi E, Ohkami H, Fujimura A. Two cases of primary thyroid disease and hip fracture. Hosp Med. 2003, 64;1:54-5  Back to cited text no. 8    

Top
Correspondence Address:
B Pasupathy
32, Subramaniyapuram , Kolathur, Chennai - 600 099
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.36629

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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