Simultaneous bilateral valgus slipped capital femoral epiphysis in an 11-year-old girl: a case report




Bowman, W.
Mayfield, Matthew


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Background: Slipped capital femoral epiphysis (SCFE) is a unique emergent hip disorder that afflicts children and teenagers. The most common presentation of SCFE is varus slip, a posterior and inferior displacement of the proximal femoral epiphysis on the femoral metaphysis; however, SCFE also presents less frequently as a valgus slip, a posterior and lateral displacement. Bilateral SCFE happens even less often than unilateral SCFE, so a case of simultaneous bilateral valgus SCFE is unique. Case Information: This case was identified and reviewed using electronic medical records and imaging. An 11-year-old normal weight girl presented with simultaneous bilateral valgus SCFE. She underwent bilateral in situ pinning to prevent further slippage, but post-surgery rapidly developed acute right hip pain caused by retained hardware that inadvertently entered the acetabulum and protruded into the inner wall of the pelvis. An additional operation took place where surgeons dislocated her right hip to remove the retained screw and revised pinnings of both hips. She faced numerous complications, including decreased sensation and numbness on the dorsum of her right foot and decreased peroneal distribution. Almost two years later she continues to experience progressive right hip pain, pinpointed to the tip of the greater trochanter on the lateral aspect of her right hip. The hardware irritation pain resolved after the removal of symptomatic hardware in the right hip. However, she still complains of severe radiating right hip pain on the anterior aspect of her hip, which displays significant acetabular dysplasia and a small cystic area on MRI. Conclusions: Valgus SCFE remains an infrequent presentation of this already uncommon musculoskeletal adolescent disorder, showing up in only 1-2% of all SCFE cases.According to the literature, simultaneous bilateral valgus SCFE in a female might be anticipated, but because of the infrequency of such cases the nature of both the presentation and demographics are still being discovered and understood. Usually, SCFE presents as a unilateral slip, although patients can have either sequential or simultaneous bilateral slips. In fact, most studies show that approximately 35% of SCFE cases present as bilateral slips. Some results have suggested that bilateral slips may be more common in valgus SCFE than in varus SCFE. More specifically, bilateral valgus SCFE might typically present simultaneously, rather than sequentially.