A 16-year-old boy presented with bilateral groin pain and limp (R > L) for 3 months. He was obese (BMI:31.4) with features of hypogonadism (Fig. 1). Right hip had fixed external rotation deformity and movements were restricted. Plain radiographs revealed bilateral Slipped Capital Upper Femoral Epiphysis (SCUFE): Grade III on right and Grade I on left side (Fig. 2). Serum Vitamin D level was low (12 ng/ml). He was treated by in situ fixation of the slippage of both hips, by 2 cancellous screws (Fig. 3) followed by immediate relief of pain.

1.
Bilater
ral hip paiin with hy
ypogonaddism

2. Interesting Rare Case Pictures
Bilateral hip pain with hypogonadism
Raju Vaishya a
, Vipul Vijay b
, Abhishek Vaish c
a
Sr Consultant, Department of Orthopedics, Indraprastha Apollo Hospitals, Sarita Vihar, India
b
Associate Consultant, Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, India
c
PG student, Department of Orthopaedics, Sancheti Institute of Orthopaedics, Pune, India
a r t i c l e i n f o
Article history:
Received 1 April 2014
Accepted 2 April 2014
Available online 3 June 2014
A 16-year-old boy presented with bilateral groin pain and
limp (R > L) for 3 months. He was obese (BMI:31.4) with fea-
tures of hypogonadism (Fig. 1). Right hip had fixed external
rotation deformity and movements were restricted. Plain
radiographs revealed bilateral Slipped Capital Upper Femoral
Epiphysis (SCUFE): Grade III on right and Grade I on left side
(Fig. 2). Serum Vitamin D level was low (12 ng/ml). He was
treated by in situ fixation of the slippage of both hips, by 2
cancellous screws (Fig. 3) followed by immediate relief of
pain.
The common presentation of SCUFE include pain, limp,
and decreased range of motion of the hip.1
It is often found
in peripubertal age (boys > girls) and bilateral involvement
is common. The precise aetiology is not known. Conditions
which weaken the epiphysis including endocrinal and
metabolic disorders (e.g. obesity, hypothyroidism, pan hy-
popituitarism and Vitamin D deficiency) are commonly
associated with it.2
SCUFE occurs due to disruption through
the growth plate, resulting in slippage of epiphysis over the
neck of femur. Normally, a line passing from the superior
border of the neck of femur (Klein’s line) transects the
femoral head but in SCUFE the capital physis lies inferior to
the line due to the slip (Trethowan’s sign), on a plain
radiograph. Early treatment of the slips is by in situ
Fig. 1 e Inguinal region showing features of
hypogonadism.
E-mail address: raju.vaishya@gmail.com (R. Vaishya).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 1 4 5 e1 4 6
http://dx.doi.org/10.1016/j.apme.2014.04.002
0976-0016/Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.

3. fixation with pins or screws. In delayed presentation and
severe slippage, an open reduction of the physis and fixa-
tion or a subcapital or intertrochanteric osteotomy may be
required.3
Slipped capital upper femoral epiphysis (SCUFE) is com-
mon in young adolescent (males females) and usually
present with pain and limp.
SCUFE is commonly associated with hypogonadism,
endocrinal abnormalities and vitamin D deficiency.
Surgical fixation of the SCUFE (in situ) is the treatment of
choice.
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
1. Aronsson DD, Loder RT, Breur GJ, et al. Slipped capital femoral
epiphysis: current concepts. J Am Acad Orthop Surg.
2006;14(12):666e679.
2. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis
associated with vitamin D deficiency: a series of 15 cases. Bone
Joint J. 2013 Jun;95-B(6):851e854.
3. Peck K, Herrera-Soto J. Slipped capital femoral epiphysis:
what’s new? Orthop Clin North Am. 2014 Jan;45(1):77e86.
Fig. 2 e AP radiograph of the hips showing slipped capital
upper femoral epiphyses (R L).
Fig. 3 e APradiographof bothhipsshowing fixationofSCUFE
(in situ) by 2 cannulated cancellous screws on each side.
a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 1 4 5 e1 4 6146

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