Bilateral Slipped Capital Femoral Epiphysis Due to Primary Hyperparathyroidism - A Case Report -

Tai-Seung Kim; Wan-Sun Choi

doi:10.4055/jkoa.2009.44.5.565

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Kim and Choi: Bilateral Slipped Capital Femoral Epiphysis Due to Primary Hyperparathyroidism - A Case Report -

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(5): 565-569.

Published online: 23 September 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.5.565

Bilateral Slipped Capital Femoral Epiphysis Due to Primary Hyperparathyroidism - A Case Report -

Tai-Seung Kim, M.D., Wan-Sun Choi, M.D.

Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea.

Correspondence to Tai-Seung Kim, M.D. Department of Orthopaedic Surgery, College of Medicine, Hanyang University, 17, Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. Tel: +82.2-2290-8485, Fax: +82.2-2299-3774, kimts@hanyang.ac.kr

Received 13 December 2008 Accepted 18 May 2009

Abstract

Slippage of the upper femoral epiphysis can occur in association with endocrine disorder. A 14-year-old male patient, who complained of pain on multiple joints including both hips, was diagnosed with bilateral slipped femoral epiphysis due to primary hyperparathyroidism. At a single operation, the epiphyses were pinned-in situ, and the tumor was removed. After parathyroidectomy, the calcium and the parathyroid hormone levels promptly resolved. The pinning-in situ of both femoral heads was done for the purpose of preventing further displacement of the femoral epiphyses, and we aimed for epiphysiodesis. The permanent biopsy of the tumor was parathyroid adenoma. The physes of both femoral heads were closed and the widened physes of both distal tibias resolved postoperatively.

Keywords: Slipped capital femoral epiphysis, Primary hyperparathyroidism

Figures and Tables

Fig. 1

Both hip anteroposterior radiograph showing widening of both femoral epiphyseal plate.

Fig. 2

(A) Right ankle anteroposterior radiograph showing widening of distal tibial epiphyseal plate. (B) The epiphyseal plate of right distal tibia narrowed at postoperatively nine months later.

Fig. 3

The axial image of pelvic bone computerized tomograph showing widening of both femoral epiphyseal plate and mild posterior migration of both femoral epiphyses.

Fig. 4

Parathyroid scan showing hot uptake on right lower parathyroid gland.

Fig. 5

The epiphyseal plates of both femoral head were pinned in situ.

Fig. 6

The pins in both femoral head were removed at postoperatively nine months later. And the follow-up radiograph showing completely closing femoral capital epiphyseal plates.

Fig. 7

(A) The subperiosteal resorptions of phalanges were shown preoperatively. (B) The subperiosteal resorption of phalanges were reduced after operation.

Fig. 8

(A) The lamina dura in teeth was absent preoperatively. (B) The lamina dura in teeth were newly developed postoperatively.

Table 1

Laboratory Findings

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