Hi, this is Sagar Wagle, one of the musculoskeletal radiology fellows at Stanford University. We have a 10-year-old female with 4 months of right hip pain. In this AP radiograph of the pelvis, this line drawn tangentially along the lateral aspect of the femoral neck, this is called the Klein line. This should intersect the femoral epiphysis and some of the femoral head should be lateral to the line. So this is normal side. On the contralateral side, we can see that the Klein line does not intersect the femoral head and we do not see the femoral epiphysis lateral to the line. So this is consistent with slipped capital femoral epiphysis, which is a type of type 1 Salty-Harris fracture. The growth plate, also called the physis, is the weakest point in pediatric skeleton and type 1 Salty-Harris fracture goes through the growth plate. This is frog leg view of the patient and here we can see the slip of the femoral head when you compare it to the normal contralateral side. Patient was treated with percutaneous pinning and here if we draw the Klein line, we can see that some of the femoral head lies lateral to the line. So this is improved alignment. Here we can see the 2-week post-op image and 6-week post-op image, which shows expected finding and we do see a little bit of femoral head lateral to the Klein line. If there is high clinical suspicion for slipped capital femoral epiphysis, also called SCIFI and radiographs are negative, CT or MRI can be helpful. MRI has the highest sensitivity, however, it could be difficult to obtain MRI, so CT is still helpful. Thank you for watching the video.

3rd Edition, CASE 45

3rd Edition

Pediatric Issues

slipped capital femoral epiphysis

Salter-Harris fracture

percutaneous pinning

pediatric hip pain

Klein line