Download PDF
CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(06): e922-e935
DOI: 10.1055/s-0044-1790578
Artigo Original
Ortopedia Pediátrica

The Peritubercle Lucency Sign as a Considerable Predictive Factor for Contralateral Hip Slippage in Unilateral Slipped Capital Femoral Epiphysis Cases

Article in several languages: português | English
Anastácio Kotzias Neto
1   Departamento de Ortopedia Pediátrica, Hospital Infantil Joana de Gusmão, Florianópolis, SC, Brasil
,
Renan Vinicius Romano Martinelli 
1   Departamento de Ortopedia Pediátrica, Hospital Infantil Joana de Gusmão, Florianópolis, SC, Brasil
,
Marthina Alice Gressler
1   Departamento de Ortopedia Pediátrica, Hospital Infantil Joana de Gusmão, Florianópolis, SC, Brasil
,
Marco Aurélio de Oliveira
1   Departamento de Ortopedia Pediátrica, Hospital Infantil Joana de Gusmão, Florianópolis, SC, Brasil
› Author Affiliations Financial Support The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective To determine whether the radiographic parameter at the epiphyseal tubercle region (peritubercle lucency sign) on the unaffected side can predict slipped capital femoral epiphysis (SCFE).

Methods We retrospectively reviewed patients who received an initial diagnosis of unilateral SCFE between 1995 and 2020 at a pediatric hospital in a Brazilian state's capital. The patients were monitored for at least 18 months. Two reviewers independently and blindly assessed the radiographs for the presence or absence of the sign. Disagreements were resolved by a third senior reviewer.

Results Out of the 115 cases reviewed, the peritubercle lucency sign was observed in 21 of the 30 patients who developed the disease in the contralateral hip. The sign was observed on an average of 21 days after the diagnosis on the initial side, and approximately 301 days prior to the condition affecting the contralateral hip. It was present in 95% and 85% of the cases on the lateral (frog-leg) and anteroposterior (AP) views, respectively. Interobserver reliability was measured using the Kappa test (k = 0.0801). There was a significant relationship between the presence of the sign and SCFE (p < 0.001).

Conclusions: We propose that the peritubercle lucency sign can be used as a supplementary tool in early diagnosis, for it is beneficial in the therapeutic planning.

Level Of Evidence: Level III – Diagnostic Study In Nonconsecutive Patients (Without Consistently Applied ‘Gold Standard’ As Reference)

Keywords

early diagnosis - hip - radiography - slipped capital femoral epiphysis

Author Contributions:

Each author contributed individually and significantly to the development of this research. AK: development of the research project, evaluator 3, writing of the article, and text review; RVRM: development of the research project, evaluator 1, writing of the article, text review, and bibliographical review; MAG: development of the research project, evaluator 2, writing of the article, and literature review; and MAO: development of the research project, search of records and radiographs and writing of the article.


Work carried out at the Department of Pediatric Orthopedics, Hospital Infantil Joana de Gusmão, Florianópolis, SC, Brazil.




Publication History

Received: 20 March 2024

Accepted: 23 June 2024

Article published online:
21 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Kotzias Neto A. Epiphysiolysis proximal femur. In: Herbert SK, Barros Filho TEP, Xavier R, Pardini Junior AG. eds. Orthopedics and Traumatology – Principles and Practice. 5a. ed. Porto Alegre:: Artmed; 2016: 300-319
    Search in Google Scholar
  • 2 Griffith MJ. Slipping of the capital femoral epiphysis. Ann R Coll Surg Engl 1976; 58 (01) 34-42
    PubMedSearch in Google Scholar
  • 3 Tayton K. Does the upper femoral epiphysis slip or rotate?. J Bone Joint Surg Br 2007; 89 (10) 1402-1406
    CrossrefPubMedSearch in Google Scholar
  • 4 Novais EN, Maranho DA, Kim YJ, Kiapour A. Age- and Sex-Specific Morphologic Variations of Capital Femoral Epiphysis Growth in Children and Adolescents Without Hip Disorders. Orthop J Sports Med 2018; 6 (06) 2325967118781579
    CrossrefPubMedSearch in Google Scholar
  • 5 Liu RW, Armstrong DG, Levine AD, Gilmore A, Thompson GH, Cooperman DR. An anatomic study of the epiphyseal tubercle and its importance in the pathogenesis of slipped capital femoral epiphysis. J Bone Joint Surg Am 2013; 95 (06) e341-e348
    PubMedSearch in Google Scholar
  • 6 Kleinman PK, Marks Jr SC, Spevak MR, Belanger PL, Richmond JM. Extension of growth-plate cartilage into the metaphysis: a sign of healing fracture in abused infants. AJR Am J Roentgenol 1991; 156 (04) 775-779
    CrossrefPubMedSearch in Google Scholar
  • 7 Crawford AH. Slipped capital femoral epiphysis. J Bone Joint Surg Am 1988; 70 (09) 1422-1427
    CrossrefPubMedSearch in Google Scholar
  • 8 Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am 1993; 75 (08) 1141-1147
    CrossrefPubMedSearch in Google Scholar
  • 9 Morrissy RT. Slipped capital femoral epiphysis - Natural history and etiology in treatment. Instr Course Lect 1980; 29: 81-86
    Search in Google Scholar
  • 10 Jensen HP, Steinke MS, Mikkelsen SS, Thomsen PB. Hip physiolysis. Bilaterality in 62 cases followed for 20 years. Acta Orthop Scand 1990; 61 (05) 419-420
    CrossrefPubMedSearch in Google Scholar
  • 11 Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 1967; 49 (05) 807-835
    CrossrefPubMedSearch in Google Scholar
  • 12 Barrios C, Blasco MA, Blasco MC, Gascó J. Posterior sloping angle of the capital femoral physis: a predictor of bilaterality in slipped capital femoral epiphysis. J Pediatr Orthop 2005; 25 (04) 445-449
    CrossrefPubMedSearch in Google Scholar
  • 13 Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84 (04) 556-560
    CrossrefPubMedSearch in Google Scholar
  • 14 Steppacher SD, Tannast M, Werlen S, Siebenrock KA. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res 2008; 466 (04) 782-790
    CrossrefPubMedSearch in Google Scholar
  • 15 Laredo Filho J, Braga Jr MB, Ishida A, Bortoletto A. Estudo crítico da indicação da pinagem preventiva do lado sadio na epifisiólise proximal do fêmur unilateral. Rev Bras Ortop 1987; 22 (06) 173-176
    Search in Google Scholar
  • 16 Santili C. Epifisiólise. Rev Bras Ortop 2001; 36 (03) 49-56
    Search in Google Scholar
  • 17 Mestriner MB, Verquietini CM, Waisberg G, Akkari M, Fukunaga ET, Santili C. Radiographic evaluation in epiphysiolysis: possible predictors of bilaterality?. Acta Ortop Bras 2012; 20 (04) 203-206
    PubMedSearch in Google Scholar
  • 18 Maranho DA, Ferrer MG, Kim YJ, Miller PE, Novais EN. Predicting Risk of Contralateral Slip in Unilateral Slipped Capital Femoral Epiphysis: Posterior Epiphyseal Tilt Increases and Superior Epiphyseal Extension Reduces Risk. J Bone Joint Surg Am 2019; 101 (03) 209-217
    CrossrefPubMedSearch in Google Scholar
  • 19 Maranho DA, Miller PE, Novais EN. The Peritubercle Lucency Sign is a Common and Early Radiographic Finding in Slipped Capital Femoral Epiphysis. J Pediatr Orthop 2018; 38 (07) e371-e376
    CrossrefPubMedSearch in Google Scholar
  • 20 National Center for Health Statistics. CDC Growth Charts [Centers for Disease Control and Prevention website]. December 15, 2022 . Available at: https://www.cdc.gov/growthcharts/cdc_charts.htm . [Accessed in 07/10/2023].
    Search in Google Scholar
  • 21 Fahey JJ, O'Brien ET. Acute slipped capital femoral epiphysis: review of the literature and report of ten cases. J Bone Joint Surg Am 1965; 47: 1105-1127
    CrossrefPubMedSearch in Google Scholar
  • 22 Wilson PD, Jacobs B, Schecter L. Slipped capital femoral epiphysis: an end-result study. J Bone Joint Surg Am 1965; 47: 1128-1145
    CrossrefPubMedSearch in Google Scholar
  • 23 Maranho DA, Bixby SD, Miller PE. et al. What Is the Accuracy and Reliability of the Peritubercle Lucency Sign on Radiographs for Early Diagnosis of Slipped Capital Femoral Epiphysis Compared With MRI as the Gold Standard?. Clin Orthop Relat Res 2020; 478 (05) 1049-1059
    CrossrefPubMedSearch in Google Scholar
  • 24 Song KM. CORR Insights®: What is the Accuracy and Reliability of the Peritubercle Lucency Sign on Radiographs for Early Diagnosis of Slipped Capital Femoral Epiphysis Compared With MRI as the Gold Standard?. Clin Orthop Relat Res 2020; 478 (05) 1060-1061
    CrossrefPubMedSearch in Google Scholar
  • 25 Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960; 20 (01) 37-46
    CrossrefSearch in Google Scholar
  • 26 Brown DW, Iorio TJ, Mosher ZA. et al. Intraobserver and interobserver reliability of the peritubercle lucency sign in slipped capital femoral epiphysis. J Pediatr Orthop 2021; 41 (03) 159-163
    CrossrefPubMedSearch in Google Scholar