Slipped Capital Femoral Epiphysis SCFE

مظلومی دکترپزشکی علوم دانشگاه ارتوپدی دانشیار

مشهد

Slip Capital Femoral Epiphyses

INCIDENCE AND EPIDEMIOLOGY

• The usual deformity consists of an upward and anterior movement of the femoral neck on the capital epiphysis.

• The incidence of SCFE varies according to race, sex, and geographic location: The incidence is

estimated to be approximately 2 per 100,000 population,

INCIDENCE AND EPIDEMIOLOGY

• There is a definite predilection for males to be affected more often than females(5/1), and

for the left hip to be affected more often than the right(3/1).

• Slipped epiphysis typically occurs during adolescence (boys, 13 to 15 years of age, averaging about 14years; and girls, 11to 13years of age, averaging about 12 years) a period of maximal skeletal growth.

INCIDENCE AND EPIDEMIOLOGY

• When SCFE occurs in a juvenile (10 years of age and younger) or in a patient with an open physis older than 16 years of age, careful assessment for an underlying Endocrinopathy should be considered.

• Most studies identify bilateral involvement either on initial presentation or subsequently in approximately 20% to 25% of patients

CLASSIFICATION

• According to onset of symptoms (acute, chronic, or acute-an-chronic)

• functionally, according to the patient's ability to bear weight (stable or unstable)

• or morphologically, as to the extent of displacement of the femoral epiphysis relative to the neck (mild, moderate, or severe),

CLASSIFICATION

• An acute SCFE has been characterized as one occurring in a patient with prodromal symptoms for 3 weeks or less

• Acute slips present as a sudden, dramatic, fracture-like episode occurring after trauma

too trivial to cause displacement of the epiphysis as a Salter- Harris type I fracture

CLASSIFICATION

• Chronic SCFE is the most frequent form of presentation. Typically, an adolescent presents with a few months history of vague groin pain, upper or lower thigh pain, and a limp.

• Radiographs of patients with chronic SCFE show a variable amount of posterior migration of the femoral epiphysis and remodeling of the femoral neck in the same direction

CLASSIFICATION

• The acute-on-chronic slipped epiphysis is one in which features of both ends of the spectrum are present

• prodromal symptoms have been present for more than 3 weeks with a sudden exacerbation of pain, and radiographic evidence of both femoral neck remodeling and further displacement

Classification

• Functional Classification• Patients who were unable to bear weight after

the acute episode were identified as having unstable slips.

• those who were able to bear weight at the time of presentation to a physician were classified as having stable slips

Morphologic Classification

Head-shaft angle

mild slips less than 30 degrees from the normal contralateral side moderate slips theangle difference is between 30 and 60 degreessevere slips the angle differs by more than 60 degrees from the contralateral normal side.

ETIOLOGY

• Mechanical Factors• THINNING OF THE PERICHONDRIAL RING COMPLEX• RELATIVE OR ABSOLUTE FEMORAL RETROVERSION• CHANGE IN INCLINATION OF THE ADOLESCENT

PROXIMAL FEMORAL PHYSIS RELATIVE TO THE FEMORAL NECK AND SHAFT

• ASSOCIATED CONDITIONS Blount's disease , peroneal spastic flat foot and Legg-

Calve-Perthes disease.

ETIOLOGY

Endocrine Factors• The stereotype of an obese, hypogonadal

male (the so-called adiposogenital syndrome) presenting with chronic bilateral slipped epiphyses has long stimulated the thought that some alteration in the balance of thyroid, growth, and sex hormones was the cause of slipped epiphysis

CLINICAL FEATURES

Stable, Chronic Slipped Capital Femoral Epiphysis

• pain in the region of the groin, which may be referred to the anteromedial aspect of the

thigh and knee.• The loss of internal rotation on examination,

with complaints of pain at the limit of internal rotation, is a key finding in stable SCFE.

Clinical features

Unstable Acute or Acute-on-Chronic Slipped Capital Femoral Epiphysis

• severe, fracture-like pain in the affected hip region, usually as the result of a relatively minor fall or twisting injury.

• the patient unable to bear weight and likely to seek prompt medical attention.

RADIOGRAPHIC FINDINGS

Plain RadiographyAP and lateral views

(Klein's line) on the AP view

TREATMENTSTABLE SLIPPED CAPITAL FEMORAL EPIPHYSIS

Percutaneous In Situ Fixation with a Fracture Table

treatment

Femoral neck osteotomy

COMPLICATIONS

Chondrolysis1- acute cartilage necrosis2- stiffness and persistent pain in the groin Loss of joint space3- The incidence of chondrolysis is 1.5%

Avascular NecrosisThe most severe complication associated with SCFE is the development of AVN of the epiphysis.