Bilater      

ral hip paiin with hy 

  

ypogonaddism

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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, IndiabAssociate Consultant, Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, IndiacPG 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

E-mail address: raju.vaishya@gmail.comhttp://dx.doi.org/10.1016/j.apme.2014.04.0020976-0016/Copyright ª 2014, Indraprastha M

Fig. 1 e Inguinal region showing features of

hypogonadism.

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

(R. Vaishya).

edical Corporation Ltd. All rights reserved.

Fig. 2 e AP radiograph of the hips showing slipped capital

upper femoral epiphyses (R > L).

Fig. 3 e APradiographofbothhipsshowingfixationofSCUFE

(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 5e1 4 6146

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 femoralepiphysis: current concepts. J Am Acad Orthop Surg.2006;14(12):666e679.

2. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysisassociated with vitamin D deficiency: a series of 15 cases. BoneJoint 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.

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