Ortho Preferred Malpractice Insurance
Home » Joints » Hip » Slipped Capital Femoral Epiphysis:

Slipped Capital Femoral Epiphysis:

- 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; 
    - references:
           - An Anatomic Study of the Epiphyseal Tubercle and Its Importance in the Pathogenesis of Slipped Capital Femoral Epiphysis
           - Radiological findings that may indicate a prior silent slipped capital femoral epiphysis in a cohort of 2072 young adults

- 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, 
    - loss of internal rotation and/or tenderness of internal rotation;
    - acute slip:
    - acute on chronic slip:
    - chronic slip
    - may present with knee pain alone (referred pain): 
            - Knee pain as the initial symptom of slipped capital femoral epiphysis: an analysis of initial presentation and treatment
            - Delay in diagnosis of slipped capital femoral epiphysis.

- 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
    - vitamin D deficiency
            - Slipped Capital Femoral Epiphysis With Severe Vitamin D Deficiency
    - leptin: The End of the Road for Idiopathic Slipped Capital Femoral Epiphysis?: Commentary on an article by Schuyler J. Halverson, MD, MS, et al.: "Leptin Elevation as a Risk Factor for Slipped Capital Femoral Epiphysis Independent of Obesity Status".

- 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.
                 - The treatment of an unstable slipped capital femoral epiphysis by either intracapsular cuneiform osteotomy or pinning in situ: a comparative study.
                 - Osteonecrosis After Contralateral in Situ Prophylactic Pinning for a 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
    - 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.

Outcomes of Slipped Capital Femoral Epiphysis Treated With In Situ Pinning