Slipped capital femoral epiphysis

Slipped Capital Femoral Epiphysis
Slipped capital femoral epiphysis.jpg
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Hip pain, knee pain, limping
Complications	Avascular necrosis, osteoarthritis
Onset	Adolescence
Duration
Types	N/A
Causes	Unknown, risk factors include obesity, hormonal changes
Risks	Obesity, endocrine disorders
Diagnosis	X-ray, MRI
Differential diagnosis	N/A
Prevention	N/A
Treatment	Surgery, physical therapy
Medication	N/A
Prognosis	Good with early treatment
Frequency	10.8 per 100,000 children
Deaths	N/A

Slipped Capital Femoral Epiphysis (SCFE) is a medical condition affecting the hip joint in adolescents. It occurs when the femoral head slips off the femoral neck through the growth plate (physis). This condition is considered an orthopedic emergency due to the risk of avascular necrosis and long-term osteoarthritis.

Epidemiology

SCFE is the most common hip disorder in adolescents, with an incidence of approximately 10.8 per 100,000 children. It typically occurs during the adolescent growth spurt, between the ages of 10 and 16 years. The condition is more prevalent in males than females and is more common in African American and Hispanic populations.

Etiology

The exact cause of SCFE is unknown, but several risk factors have been identified:

• Obesity: Increased body weight places additional stress on the growth plate.
• Endocrine disorders: Conditions such as hypothyroidism, growth hormone deficiency, and hypogonadism are associated with SCFE.
• Genetic factors: There may be a hereditary component, as SCFE can occur in families.

Pathophysiology

In SCFE, the epiphyseal plate (growth plate) becomes weakened, allowing the femoral head to slip posteriorly and inferiorly relative to the femoral neck. This slippage disrupts the normal alignment of the hip joint and can lead to impaired blood supply to the femoral head, increasing the risk of avascular necrosis.

Clinical Presentation

Patients with SCFE typically present with:

• Hip pain: Often referred to the knee, leading to diagnostic confusion.
• Limping: Due to pain and mechanical instability of the hip.
• Limited range of motion: Particularly in internal rotation and abduction.

Diagnosis

The diagnosis of SCFE is primarily made through imaging studies:

• X-ray: The primary diagnostic tool, showing displacement of the femoral head relative to the femoral neck.
• MRI: Useful in early or atypical cases to assess the growth plate and surrounding structures.

Classification

SCFE is classified based on the degree of slippage:

• Stable SCFE: The patient can walk with or without crutches.
• Unstable SCFE: The patient cannot walk, even with crutches, and is at higher risk for complications.

Treatment

The primary treatment for SCFE is surgical intervention:

• In situ pinning: The most common procedure, involving the insertion of a single screw to stabilize the femoral head.
• Open reduction and internal fixation: Used in severe cases to realign the femoral head.

Post-surgical management includes physical therapy to restore hip function and prevent complications.

Prognosis

With early diagnosis and appropriate treatment, the prognosis for SCFE is generally good. However, delayed treatment can lead to complications such as avascular necrosis and osteoarthritis, which may require further surgical intervention.

Complications

• Avascular necrosis: Loss of blood supply to the femoral head, leading to bone death.
• Chondrolysis: Rapid loss of articular cartilage, resulting in joint stiffness and pain.
• Osteoarthritis: Degenerative joint disease due to abnormal joint mechanics.

Prevention

While SCFE cannot be entirely prevented, early recognition and management of risk factors such as obesity and endocrine disorders can reduce the likelihood of occurrence.

See also

• Hip dysplasia
• Legg-Calvé-Perthes disease