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[Delayed diagnosis of epiphysiolysis capitis femoris]
Insights
Delayed diagnosis of epiphysiolysis of the head of the femur (ECF) significantly impacts prognosis. Misdiagnosed hip pain, often presenting as knee or thigh pain, contributes to prolonged delays in ECF diagnosis and treatment.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Epiphysiolysis of the head of the femur (ECF) requires prompt treatment for optimal prognosis.
- Delayed diagnosis is a significant factor contributing to poor outcomes in ECF.
Purpose of the Study:
- To analyze the reasons for and extent of delayed diagnosis in pediatric ECF.
- To identify factors contributing to diagnostic delays in ECF.
Main Methods:
- Retrospective analysis of 56 children (72 hips) diagnosed with ECF.
- Evaluation of patient-related and physician-related delays.
- Review of clinical findings and radiographic interpretations.
Main Results:
- Median diagnostic delay was six months, with significant contributions from both patient (1 month) and physician (3 months) factors.
- Atypical pain presentation (knee/thigh pain) in one-third of patients led to longer physician delays (median 4 months).
- Erroneous X-ray interpretation was noted in 14 patients; limited internal rotation of the hip was the most characteristic clinical sign.
Conclusions:
- Diagnostic delays in ECF remain a persistent issue, unchanged over the past 35 years.
- Clinical hip examination is crucial for children with knee or thigh pain.
- Suspected ECF warrants radiographic evaluation (including Lauenstein's projection) or orthopedic referral if internal rotation is limited.
Abstract:
The prognosis in epiphysiolysis of the head of the femur (ECF) depends on immediate treatment in the earliest stage of the disease. The reasons for and the extent of delayed diagnosis of slipping of the epiphysis in the hip were analysed in 56 children (72 hips) with ECF. The median total delay was six months with a delay of one month due to the patient and delay of three months due to the doctor. Pain in the lower limbs not related to the hip, including pain in the knee, occurred in 1/3 of the patients and resulted in more extensive delays due to the doctor (median four months). Other reasons for delay due to the doctor were erroneous interpretation of the x-ray films (14 patients). The most characteristic clinical finding was limited internal rotation of the affected hip. Comparison with the literature revealed that delay in the diagnosis of ECF has not been reduced during the past 35 years. Clinical examination of the hips should be undertaken in any child who complains of pain in the knee or thigh. If internal rotation is limited, x-ray examination including Lauenstein's projection should be carried out or the child should be referred to a department of orthopaedic surgery on account of suspected hip disease.