View source for Neck of femur fracture differential diagnosis

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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Neck_of_femur_fracture]]
{{CMG}}; {{AE}} {{Rohan}}

==Overview==
Neck of femur fracture must be differentiated from other causes of acute [[hip]] pain, [[restriction of movements]], and [[deformity]] such as [[intertorchanteric hip fracture]], [[osteoarthritis]], [[avascular necrosis]], [[septic arthritis]], [[Trochanteric bursitis|trochanteric]] [[bursitis]], [[slipped capital femoral epiphysis]] and acute [[synovitis]].

==Differentiating Neck of Femur Fracture from other Diseases==
* Neck of femur fracture must be differentiated from other causes of acute [[hip]] pain, [[restriction of movements]], and [[deformity]] such as [[intertorchanteric hip fracture]], [[osteoarthritis]], [[avascular necrosis]], [[septic arthritis]],  [[Trochanteric bursitis|trochanteric]] [[bursitis]], [[slipped capital femoral epiphysis]] and acute [[synovitis]].<ref>{{cite book | last = Rockwood | first = Charles | title = Rockwood and Green's fractures in adults | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia, PA | year = 2010 | isbn = 9781605476773 }}</ref><ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323374620 }}</ref><ref name="pmid23522513">{{cite journal| author=Hall M, Anderson J| title=Hip pointers. | journal=Clin Sports Med | year= 2013 | volume= 32 | issue= 2 | pages= 325-30 | pmid=23522513 | doi=10.1016/j.csm.2012.12.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23522513  }} </ref><ref name="pmid23395055">{{cite journal| author=Kelly BT, Maak TG, Larson CM, Bedi A, Zaltz I| title=Sports hip injuries: assessment and management. | journal=Instr Course Lect | year= 2013 | volume= 62 | issue=  | pages= 515-31 | pmid=23395055 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23395055  }} </ref><ref name="pmid24082863">{{cite journal| author=Poultsides LA, Bedi A, Kelly BT| title=An algorithmic approach to mechanical hip pain. | journal=HSS J | year= 2012 | volume= 8 | issue= 3 | pages= 213-24 | pmid=24082863 | doi=10.1007/s11420-012-9304-x | pmc=3470663 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082863  }} </ref><ref name="pmid27857636">{{cite journal| author=Battaglia PJ, D'Angelo K, Kettner NW| title=Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging. | journal=J Chiropr Med | year= 2016 | volume= 15 | issue= 4 | pages= 281-293 | pmid=27857636 | doi=10.1016/j.jcm.2016.08.004 | pmc=5106442 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27857636  }} </ref><ref name="pmid19038713">{{cite journal| author=Tibor LM, Sekiya JK| title=Differential diagnosis of pain around the hip joint. | journal=Arthroscopy | year= 2008 | volume= 24 | issue= 12 | pages= 1407-21 | pmid=19038713 | doi=10.1016/j.arthro.2008.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038713  }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="3" rowspan="2" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|- 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Active Straight Leg Raising
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Distal Pulses
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Neck of Femur Fracture
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Shortening]]
*[[External rotation|Externally rotated]] leg
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Fracture]] fragment displacement
*[[Fracture]] fragment angulation
| style="background: #F5F5F5; padding: 5px;" |
*Accurate [[diagnosis]] of [[Fracture|fractur]]<nowiki/>e pattern ans aids in [[classification]].
*Useful for [[Pre-operative clearance|preoperative]] [[Surgery|surgical planning]] for patients with complex, multifragmentary [[Bone fracture|fractures]].
| style="background: #F5F5F5; padding: 5px;" |
* Useful in diagnosing [[Bone fracture|occult fractures]].
| style="background: #F5F5F5; padding: 5px;" |[[X-rays|X-ray]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Bone scan]] shows increased uptake of [[radioactivity]] in region of [[fracture]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hip fracture|Intertrochanteric Hip Fracture]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Shortening]]
*[[External rotation|Externally rotated]] leg
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Fracture]] fragment displacement
*[[Fracture]] fragment angulation
| style="background: #F5F5F5; padding: 5px;" |
*
**Accurate [[diagnosis]] of [[Fracture|fractur]]<nowiki/>e pattern ans aids in [[classification]]. 
**Useful for [[Pre-operative clearance|preoperative]] [[Surgery|surgical planning]] for patients with complex, multifragmentary [[Bone fracture|fractures]].
| style="background: #F5F5F5; padding: 5px;" |
** Useful in diagnosin<nowiki/>g [[Bone fracture|occult fractures]].
| style="background: #F5F5F5; padding: 5px;" |[[X-rays|X-ray]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Trochanteric fossa|Trochanteric]] Thump test is positive.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hip fracture|Subtrochanteric Femur Fracture]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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*[[Thigh]] is deformed
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Fracture]] fragment displacement
*[[Fracture]] fragment angulation
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*<nowiki/><nowiki/> Accurate [[diagnosis]] of [[Fracture|fractur]]<nowiki/>e pattern ans aids in [[classification]].
*Useful for [[Pre-operative clearance|preoperative]] [[Surgery|surgical planning]] for patients with complex, multifragmentary [[Bone fracture|fractures]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Useful in diagnosing [[Occult fracture|occult fractures]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[X-rays|X-ray]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Acetabular labrum|Acetabular]] [[Fracture]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Fracture]] fragment displacement
*[[Fracture]] fragment angulation
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Accurate [[diagnosis]] of [[Fracture|fractur]]<nowiki/>e pattern ans aids in [[classification]]. 
*<nowiki/>Useful for [[Pre-operative clearance|preoperative]] [[Surgery|surgical planning]] for patients with complex, multifragmentary [[Bone fracture|fractures.]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Useful in diagnosing [[Occult fracture|occult fractures]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[CT-scans|CT]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*It is a [[medical emergency]] as there is a large amount of [[blood loss]].
*Per [[urethral]] [[blood]] may be present.
*[[Swelling]] may be present in the [[Scrotal examination|scrotal]] or [[perineal]] area.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pubic bone|Pubic Rami]] [[Bone fracture|Fracture]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Fracture]] fragment displacement
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Accurate [[diagnosis]] of [[Fracture|fractur]]<nowiki/>e pattern ans aids in [[classification]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Useful in [[Diagnosis|diagnosing]] occult [[Bone fracture|fractures]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Femur|Femoral Head]] [[Fracture]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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*May be associated with [[flexion]], [[adduction]] and [[internal rotation]] deformity.
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* [[Fracture]] fragment displacement
* [[Fracture]] fragment angulation
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*
**Accurate [[diagnosis]] of [[Fracture|fractur]]<nowiki/>e pattern ans aids in [[classification]]. 
**Useful for [[Pre-operative clearance|preoperative]] [[Surgery|surgical planning]] for patients with complex, multifragmentary [[Bone fracture|fractures]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Useful in diagnosing [[Occult fracture|oc]]<nowiki/>[[Occult fracture|cult fractures]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[CT]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*It may be associated with [[Joint dislocation|dislocation]].
*It may be associated with [[foot drop]] due to compression of the [[sciatic nerve]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Osteoarthritis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Flexion]] and [[external rotation]] deformity
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Joint]] space narrowing, [[osteophytes]], subchondral [[sclerosis]] and subchondral [[Cyst|cysts]]. 
| style="background: #F5F5F5; padding: 5px;" |
*Normal
| style="background: #F5F5F5; padding: 5px;" |
*[[MRI]] shows [[Cartilage injuries|cartilage defects]] and [[bone marrow]] lesions.
| style="background: #F5F5F5; padding: 5px;" |[[X-ray]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Hip]] locking, [[instability]] and catching [[sensation]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bursitis|Trochanteric Bursitis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal
| style="background: #F5F5F5; padding: 5px;" |
*Normal
| style="background: #F5F5F5; padding: 5px;" |
*Increased signal in [[Bursa (anatomy)|bursa]] due to [[inflammation]] on T2 [[images]].
| style="background: #F5F5F5; padding: 5px;" |[[MRI]] 
| style="background: #F5F5F5; padding: 5px;" |
*Lateral [[hip]] [[pain]] near the [[greater trochanter]] and patients points to [[greater trochanter]].
*Patient may have [[trendelenburg gait]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Septic arthritis|Septic Arthritis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Joint (anatomy)|Joint]] fullness and [[Capsular ligament|capsular]] [[dilation]].
*It also demonstrates damage to the [[articular cartilage]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Fever]] and [[chills]] may be present.
*[[Arthrocentesis|Hip aspiration]] may reveal frank [[pus]] or a [[Turbid|turbid fluid]].
*[[Culture collection|Culture]] of the [[Infection|infecting]] [[Organism|organisms]] in the fluid is confirmatory.
*[[Leukocytosis]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Avascular necrosis|Avascular Necrosis of Head of Femur]]
([[Osteonecrosis]])
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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*[[Adduction]] deformity
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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*Early [[X-rays|x-ray]] findings include lucency of the [[Femoral|femoral head]]  and subchondral [[sclerosis]].
*In advanced stage, subchondral [[collapse]] (ie, [[Crescent Rising|crescent sign]]), [[Femoral|femoral head]] flattening and [[joint]] space narrowing is seen. 
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* [[CT]] shows subchondral [[collapse]].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[MRI]] shows [[bone marrow]] [[edema]] and rail track sign.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Patient may have  trendelenburg gait.
*Passive internal and external rotation of the extended leg  may elicit pain due to synovitis.
*Ficart and Arlet as well as Steinberg classification of avascular necrosis is done radiologically.
|-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acitve Straight Leg Raising
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Distal Pulses
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Femoroacetabular Impingement]]

(FAI)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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*External rotation deformity
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* '''Pistol grip deformity:''' It is asphericity and contour of femoral head and neck indicating Cam impingement.
*'''Crossover sign:''' It is a sign of acetabular retroversion seen in Pincer impingement.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* Confirms X-ray findings.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Evaluates articular cartilage damage, and labral degeneration and tears.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |MRI
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Anterior impingement test: On flexion, adduction, internal rotation of the hip produces pain.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Idiopathic Transient Osteoporosis of the Hip]] (ITOH)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* Subchondral cortical loss.
*Diffuse osteopenia of femoral head and neck.
*Joint effusion
*Joint space is always preserved
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Confirms X-ray findings.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Marrow edema of femoral head and neck
| style="background: #F5F5F5; padding: 5px; text-align: center;" |MRI
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Commonly seen among women in 3rd trimester of pregnancy and middle aged men.
*Bone scan shows increased uptake in the femoral head.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Transient synovitis|Transient Synovitis of the Hip]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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*Flexion, abduction and external rotation deformity
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*Normal
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*Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Joint space effusion
| style="background: #F5F5F5; padding: 5px; text-align: center;" |USG
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*History of recent upper respiratory tract infection or trauma to the hip.
*Fever may be present.
*Involuntary muscle guarding on log rolling of the leg.
*Ultrasound shows intracapsular effusion and synovial membrane thickening.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Slipped capital femoral epiphysis|Slipped Capital Femoral Epiphysis]]
(SCFE)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Adduction and external rotation defromity
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* '''Klein's line''': A line drawn along superior border femoral neck will intersect less of the femoral head or not at all in a child with SCFE.
*Epiphysiolysis
*'''Blanch sign of Steel''': Proximal femoral metaphyseal blurring 
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* Confirms X-ray findings.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Growth plate widening
*Edema in metaphysis 
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Antalgic gait
*'''Drehmann sign''': External rotation during passive flexion of the hip.
*Externally rotated foot progression angle.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Adult Dysplasia of the Hip
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Increased internal rotation due to increased femoral anteversion
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*External rotation deformity may be present in the late stages.
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Decreased femoral head sphericity.
*Crossover sign results from increased retroversion.
*Acetabular protrusio: Decreased lateral center-edge angle < 20°.
*Increased '''Tonnis angle''' ( angle between the horizontal line and line along the superior acetabulum)        > 10°.
*Decreased head-neck offset ratio.
*Increased femoral neck-shaft angle.
*Decreased vertical center anterior margin angle. 
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Structural abnormalities of the femoral head and neck is seen.
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |X-Ray
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Positive anterior impingement test may be seen.
|-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Restriction of Movements
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Deformity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acitve Straight Leg Raising
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Distal Pulses
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Iliospoas [[Tendinitis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Flexion and external rotation deformity
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*T2 images show an increased signal intensity associated with swelling and inflammation.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Anterior pelvic tilt due to tightening of the iliopsoas muscle.
*'''Ludloff sign:''' Patient asked to sit with knees extended and subsequent elevation of the heel on the affected side causes pain.
*Ultrasound demonstrates thickened band and fluid in the iliospoas bursa. 
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hip pointer|Hip Pointer]]
(Contusion of the Iliac Crest)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Adduction and internal rotation deformity may be present.
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal 
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[Swelling]] of the surrounding soft tissues may be seen.
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Contusion or swelling may be present.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Snapping Hip Syndrome]]
(Coxa Saltans)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*May show inflamed bursa.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Ultrasound
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*'''External snapping hip:'''  Palpate the greater trochanter as hip is actively flexed and applying pressure will likely stop snapping if external band present.
*'''Ober's Test:''' Limited hip adduction when hip held in extension indicate tightness of tensor fascia lata. 
*'''Internal snapping hip:''' Snapping is reproduced by passively moving hip from a flexed and externally rotated position to an extended and internally rotated position.
*Ultrasound shows the snapping band in either internal or external snapping.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Osteitis pubis|Osteitis Pubis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Osteolytic pubis with bony erosions
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*[[CT]] confirms [[x-ray]] findings
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Bone marrow edema is seen.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |MRI
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Bone scan shows increased activity in area of pubic symphysis.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Referred pain|Referred Pain]] from [[Lumbosacral plexus|Lumbosacral Plexus]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Narrowing of the disc space
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Compression of the nerve root and disc bulge
*Osteophytes may be seen.
| style="background: #F5F5F5; padding: 5px; text-align: center;" |MRI
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*Pain on passive straight leg raising.
|}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Orthopedics]]
[[Category:Orthopedic surgery]]
[[Category:Fractures]]
[[Category:Bone fractures]]