Re:AP pelvis and frog lateral for a limping child
Many thanks for your letter. With the benefit of hindsight, the radiographs do show signs suggestive of SUFE. However, the original radiographs were reviewed by a senior A&E doctor in a peripheral hospital, and reported by a consultant radiologist as possible Perthes. This was also the working diagnosis of a consultant paediatric orthopaedic surgeon who reviewed the chid in clinic. SUFE was not suspected possibly because of the child's very young age. An MRI was requested due to the abnormal appearance of the femoral epiphysis, but the appointment was missed. Had a frog lateral radiograph been arranged, the diagnosis would have been more obvious.
Whilst we share your concern on radiation exposure, missing the diagnosis as illustrated in this case is a bigger worry. These radiographs are routinely reviewed by junior frontline doctors that are not necessarily experienced in assessing the paediatric hip. We would normally use MRI to further investigate cases of hip pain, but in this particular case, the purpose of a CT was to delineate the bony architecture with 3D reformats to plan possible surgical intervention for the missed slip.
A frog lateral view only may well be sufficient to diagnose most hip pathology; however, we would be cautious in recommending this without prospective evidence across a large number of patients, with radiographs assessed by frontline doctors.
Conflict of Interest: