Trethowan's sign: Difference between revisions

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Trethowan's Sign

Trethowan's sign is a clinical indicator used in the diagnosis of slipped capital femoral epiphysis (SCFE), a condition affecting the hip joint in adolescents. It is named after the British surgeon John Trethowan, who first described the sign.

Description

Trethowan's sign is identified on an anteroposterior (AP) X-ray of the pelvis. It involves drawing a line along the superior border of the femoral neck (known as Klein's line) and observing its intersection with the epiphysis of the femoral head. In a normal hip, Klein's line should intersect the lateral aspect of the femoral head. In the presence of SCFE, the line does not intersect the epiphysis, indicating a slippage of the femoral head.

Clinical Significance

The presence of Trethowan's sign is a key diagnostic feature of SCFE, which is a common hip disorder in adolescents, particularly during periods of rapid growth. Early detection of SCFE is crucial to prevent further slippage and to avoid complications such as avascular necrosis of the femoral head or osteoarthritis in later life.

Diagnosis and Management

The diagnosis of SCFE is typically confirmed through radiographic imaging, with Trethowan's sign being a critical component of the assessment. Once diagnosed, the management of SCFE often involves surgical intervention to stabilize the femoral head and prevent further slippage. Common surgical procedures include in situ pinning or more complex reconstructive surgeries depending on the severity of the slip.

Related Pages

References

Loder, R. T., & Skopelja, E. N. (2011). The epidemiology and demographics of slipped capital femoral epiphysis. ISRN Orthopedics, 2011.
Kelsey, J. L., & Keggi, K. J. (1981). An epidemiological study of slipped capital femoral epiphysis. Clinical Orthopaedics and Related Research, (156), 43-47.

Images

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-'''Trethowan's sign''' is a clinical sign used in the diagnosis of [[slipped capital femoral epiphysis]] (SCFE), a common hip disorder in adolescents. The sign is named after British orthopedic surgeon, Sir [[Harry Platt]], who first described it in 1957.
+== Trethowan's Sign ==
-==Definition==
+'''Trethowan's sign''' is a clinical indicator used in the diagnosis of [[slipped capital femoral epiphysis]] (SCFE), a condition affecting the [[hip joint]] in adolescents. It is named after the British surgeon [[John Trethowan]], who first described the sign.
-Trethowan's sign is positive when there is limited internal rotation and pain on forced internal rotation of the hip. This is often associated with an outward turning (external rotation) of the leg. The sign is indicative of a slipped capital femoral epiphysis, a condition where the growth plate (epiphysis) at the top end of the thigh bone (femur) slips backwards and downwards.
-==Clinical Significance==
+== Description ==
-The presence of Trethowan's sign is a significant finding in the clinical examination of a child or adolescent presenting with hip or knee pain. It aids in the early detection of SCFE, which is crucial as delayed diagnosis and treatment can lead to complications such as [[avascular necrosis]] of the femoral head, chondrolysis, and early onset [[osteoarthritis]].
+Trethowan's sign is identified on an [[anteroposterior]] (AP) [[X-ray]] of the [[pelvis]]. It involves drawing a line along the superior border of the [[femoral neck]] (known as Klein's line) and observing its intersection with the [[epiphysis]] of the [[femoral head]]. In a normal hip, Klein's line should intersect the lateral aspect of the femoral head. In the presence of SCFE, the line does not intersect the epiphysis, indicating a slippage of the femoral head.
-==Diagnosis==
+== Clinical Significance ==
-The diagnosis of SCFE is confirmed by radiographic imaging, typically an anteroposterior and frog-leg lateral view of the hip. However, the presence of Trethowan's sign in the clinical examination can raise the suspicion of SCFE and prompt further investigation.
+The presence of Trethowan's sign is a key diagnostic feature of SCFE, which is a common hip disorder in adolescents, particularly during periods of rapid growth. Early detection of SCFE is crucial to prevent further slippage and to avoid complications such as [[avascular necrosis]] of the femoral head or [[osteoarthritis]] in later life.
-==Treatment==
+== Diagnosis and Management ==
-The treatment of SCFE is primarily surgical, aiming to stabilize the slipped epiphysis and prevent further slippage. The choice of surgical procedure depends on the severity of the slip and the skeletal maturity of the patient.
+The diagnosis of SCFE is typically confirmed through radiographic imaging, with Trethowan's sign being a critical component of the assessment. Once diagnosed, the management of SCFE often involves surgical intervention to stabilize the femoral head and prevent further slippage. Common surgical procedures include in situ pinning or more complex reconstructive surgeries depending on the severity of the slip.
-==See Also==
+== Related Pages ==
-* [[Kocher's sign]]
+* [[Slipped capital femoral epiphysis]]
-* [[Drehmann's sign]]
+* [[Hip joint]]
-* [[Hip disorders]]
+* [[Avascular necrosis]]
-* [[Pediatric orthopedics]]
+* [[Osteoarthritis]]
-==References==
+== References ==
-* Platt, H., & Trethowan, W. (1957). Slipped upper femoral epiphysis. Journal of Bone and Joint Surgery, 39(4), 802-825.
+* Loder, R. T., & Skopelja, E. N. (2011). The epidemiology and demographics of slipped capital femoral epiphysis. ISRN Orthopedics, 2011.
+* Kelsey, J. L., & Keggi, K. J. (1981). An epidemiological study of slipped capital femoral epiphysis. Clinical Orthopaedics and Related Research, (156), 43-47.
-[[Category:Medical signs]]
+== Images ==
-[[Category:Orthopedic clinical signs]]
+[[File:Trethowan's_sign_seen_in_SCFE.jpg|thumb|right|Trethowan's sign as seen in SCFE on an X-ray.]]
-[[Category:Pediatrics]]
-{{Medicine-stub}}
+[[Category:Orthopedic surgery]]
+[[Category:Radiologic signs]]