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Stress on the hip causes the epiphysis to move posteriorly and medially, relative to the metaphysis. Although it is not the epiphysis that displaced, by convention, position and alignment in SCFE is described by referring to the relationship of the proximal fragment (capital femoral epiphysis) to the normal distal fragment (femoral neck).
The angle is measured on a frog lateral view of the bilateral hips. It is measured by drawing a line perpendicular to a line connecting two points at the posterior and anterior tips of the epiphysis at the physis. A third line is drawn down the axis of femur. The angle between the perpendicular line and the femoral shaft line is the angle.
Klein's line or the line of Klein is a virtual line that can be drawn on an X-ray of an adolescent's hip parallel to the anatomically upper edge of the femoral neck.It was the first tool to aid in the early diagnosis of a slipped capital femoral epiphysis (SCFE), which if treated late or left untreated leads to crippling arthritis, leg length discrepancy and lost range of motion.
The Drehmann sign describes a clinical test of examining orthopedic patients and is widely used in the functional check of the hip joint. It was first described by Gustav Drehmann (Breslau, 1869–1932). [1] The Drehmann sign is positive if an unavoidable passive external rotation of the hip occurs when performing a hip flexion.
Trethowan's sign is when Klein's line does not intersect the lateral part of the superior femoral epiphysis on an AP radiograph of the pelvis. [ 1 ] Clinical use
Risk Factors. Risk factors for hip pain make you more likely to experience it. Some (but not all) overlap with the causes of hip pain, such as different types of arthritis and injuries.
In early skeletal development, a common physis serves the greater trochanter and the capital femoral epiphysis. This physis divides as growth continues in a balance that favors the capital epiphysis and creates a normal neck shaft angle (angle between the femoral shaft and the neck). The corresponding angle at maturity is 135 ± 7 degrees.
There are very small capital femoral epiphyses and hypoplastic, poorly formed acetabular roofs. [1] A waddling gait may develop. Knees have metaphyseal widening and irregularity while hands have brachydactyly (short fingers) and proximal metacarpal rounding. Flat feet are very common. [2]