- Discussion:
- slip of the captial femoral epiphysis occurs with in a narrow window of physiologic maturity of the growing child;
- arises from mechanical and constitutional factors;
- pts may have underlying endocrine dz (such as hypothyroidism) delayed puberty & bone age;
- position of growth plate of proximal femur normally changes from horizontal to to obliqueduring preadolescence and adolescence;
- wt increase that occurs during adolescent growth spurt puts extra strain on the growth plate;
- remember that bilateral involvement is occurs in over 25% of patients - often within 6 months of the other side;
- Clinical Findings:
- it occurs most often in boys 10-17 yrs of age (avg 12 yrs);
- in females, the average age is 12 years;
- bilateral involvement in about 1/3 of pts,
-
acute slip:
-
acute on chronic slip:
-
chronic slip:
- Radiographic Findings
- be sure to order a frog leg lateral of the opposite hip (to rule out bilateral involvement);
- Lab Findings:
-
sed rate and
CRP (which can help rule out a
septic hip when the diagnosis of SCFE is in question);
-
chemistry panel (to rule out
renal failure);
-
thyroid panel to rule out
hypothyroidism;
- patients who are on or below the 10 percentile for height at the time of presentation should be screened for hypothyroidism by measuring TSH and free
thyroxine as a preliminary screening test;
- reference: Short stature as a screening test for endocrinopathy in slipped capital femoral epiphysis S. R. Burrow, B. Alman, J. G. Wright. J Bone Joint Surg [Br] 2001;83-B:263-8.
- Treatment of SCFE:
-
reduction vs in situ pinning for SCFE
-
screw placement and number of screws:
-
pinning of the contralateral hip:
- Complications:
- aseptic necrosis is most common complication;
- references:
-
Factors Influencing the Development of Osteonecrosis in Patients Treated for Slipped Capital Femoral Epiphysis.
-
chondrolysis
- late DJD of hip;
- because acetabulum is fully formed by time SCFE occurs & dysplasia is unlikely;
- proximal femur may show concavity of the inferior region of the head neck junction, loss of concavity of the superior head and neck junction;
- references:
- Subclinical subcapital femoral epiphysis. Relationship to osteoarthritis of the hip. DA Goodman et al. JBJS. Vol 79-A No 10. Oct 1997.
-
leg length inequality:
- if reduction is incomplete or necrosis or
chondrolysis develops limb-length inequality may result;
- coxa vara, secondary to the slip & not to trochanteric overgrowth;
- References:
Prophylactic Pinning of the Contralateral Hip After Unilateral Slipped Capital Femoral Epiphysis.
Posterior Sloping Angle of the Capital Femoral Physis: A Predictor of Bilaterality in Slipped Capital Femoral Epiphysis.
Simultaneous Biplanar Fluoroscopy for the Surgical Treatment of Slipped Capital Femoral Epiphysis.
