Bilateral Valgus Slipped Capital Femoral Epiphysis in an 11-year-old Girl

Valgus slipped capital femoral epiphysis (SCFE) is very infrequent, and it is characterized by a superolateral displacement of the epiphysis on the metaphysis. To date, less than 100 cases of valgus SCFE have been described in the literature. Bilaterality of valgus SCFE is extremely rare, and it presents management challenges to the treating orthopedic surgeons. Herein, we report the case of an 11-year-old Saudi Arabian girl presented to clinic with a one-year history of bilateral hip pain and limping. Past medical history was negative for endocrinopathies, hemoglobinopathies, bone disorders, trauma or radiation therapy to the pelvis. On physical examination, the patient looked tall and obese. On clinical examination, the patient showed a waddling gait and an external rotation on walking. A frog-leg lateral radiograph showed bilateral SCFE with a valgus deformity. The right and left femoral neck-shaft angles measured 154.3 and 148.2 degrees, respectively. Computed tomography (CT) scan suggested a moderate bilateral posterior slippage of femoral heads; the right and left femoral head-neck angles measured 60 and 52 degrees, respectively. A final diagnosis of bilateral valgus SCFE was established. Consequently, the patient underwent bilateral percutaneous in situ pinning with single cannulated screws. Postoperatively, the patient made an uneventful recovery. At one-year follow-up, hip radiograph showed bilateral atypical narrowing of the joint space and suspected chondrolysis and the physis of both proximal femoral heads were fused. On the right side, the fixating screw was penetrating into the articular surface of the femoral head with some osteoarthritic changes. Considering the patient’s worsening situation, it was decided to perform a revisional surgery. The revisional surgery included the removal of bilateral screws and administration of local steroids and analgesics for pain control. Post-revisional surgery at three months, though the patient was limping with a pelvic tilt, she was able to ambulate with the aid of axillary crutches.