A 13-year-old overweight boy complains of left hip pain referred to the thigh and knee, with an antalgic limp. Frog-leg lateral radiograph shows posterior and inferior displacement of the left femoral epiphysis relative to the neck. Which radiographic line, drawn along the superior femoral neck, fails to intersect the epiphysis?

• A Shenton line
• B Hilgenreiner line
• C Perkin line
• D Klein line ✓

Explanation

Klein line is drawn along the superior cortex of the femoral neck on the anteroposterior view; normally it intersects the lateral portion of the capital epiphysis. In slipped capital femoral epiphysis the displaced epiphysis lies medial to or below this line, so it is not intersected. Shenton line assesses hip congruity in dislocation, while Perkin and Hilgenreiner lines are used in developmental dysplasia of the hip in infants. The typical patient is an overweight adolescent boy with knee-referred pain.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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