Case Series
 
A comparison of varus and valgus slipped capital femoral epiphysis: A case series
James B. Meiling1, W. Paul Bowman2,3, Matthew E. Mayfield4
13rd year medical student, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
2Chairman and Professor of Pediatrics, Department of Pediatrics, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
3Senior Pediatric Hematologist/Oncologist, Department of Hematology and Oncology, Cook Children’s Medical Center, Fort Worth, Texas, USA
4Pediatric Orthopedic Surgeon, Department of Pediatric Orthopedics, Cook Children’s Medical Center, Fort Worth, Texas, USA

Article ID: 100011Z14JM2018
doi: 10.5348/100011Z14JM2018CS

Corresponding Author:
James Bryan Meiling,
3500 Camp Bowie Boulevard,
Fort Worth, Texas, United States of America, 76107

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How to cite this article
Meiling JB, Bowman WP, Mayfield ME. A comparison of varus and valgus slipped capital femoral epiphysis: A case series. J Case Rep Images Orthop Rheum 2018;3:100011Z14JM2018.


ABSTRACT

Introduction: Slipped capital femoral epiphysis is an emergent pediatric hip disorder. It typically presents as varus slip, a posterior and inferior displacement of the proximal femoral epiphysis on the femoral metaphysis. Very rarely, it is valgus slip, a posterior and lateral displacement. This case series describes three patients with slipped capital femoral epiphysis and compares the differentiating factors observed in varus and valgus slips.

Case Series: Case 1 is an 11-year-old obese boy with pain for several months due to left unilateral varus slipped capital femoral epiphysis, who received ipsilateral in situ pinning and prophylactic pinning in the contralateral hip. Case 2 is a 12-year-old obese boy with acute pain who had right unilateral varus slipped capital femoral epiphysis, received in situ pinning, and has suspected left hip pre-slippage. Case 3 is an 11-year-old non-obese girl with acute pain revealing simultaneous bilateral valgus slipped capital femoral epiphysis, who underwent in situ pinning twice because of hardware complications.

Conclusion: The cases and current literature show that varus slips occur more often in males, while valgus slips occur more in females. Body mass index seems to show little indication in predicting the type of slip. Typically, varus slips present unilaterally and can become sequential bilateral slips, whereas valgus slips are more likely to present as simultaneous bilateral slips. Recognizing the different clinical types of slips is important because swift treatment of this emergent hip disorder depends on the immediate recognition and quick actions of orthopedic surgeons.

Keywords: Pediatric, Slipped capital femoral epiphysis, Valgus


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Acknowledgements
This case series was conducted at the Department of Orthopedics at the Dodson Clinic of Cook Children’s Medical Center, Fort Worth, TX. This study was conducted as part of the University of North Texas Health Science Center and Cook Children’s Pediatric Research Program (PRP).
Author Contributions
James B. Meiling – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published W. Paul Bowman – Substantial contributions to conception and design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Matthew E. Mayfield – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this study.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 James B. Meiling et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.