Slipped capital femoral epiphysis
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| Slipped capital femoral epiphysis | |
|---|---|
| Synonyms | SCFE, slipped upper femoral epiphysis (SUFE) |
| Pronounce | |
| Specialty | Orthopedic surgery |
| Symptoms | Hip pain, knee pain, limping |
| Complications | N/A |
| Onset | Adolescence |
| Duration | |
| Types | Stable, Unstable |
| Causes | Obesity, hormonal changes |
| Risks | Obesity, endocrine disorders, growth spurts |
| Diagnosis | X-ray, physical examination |
| Differential diagnosis | Hip dysplasia, Legg-Calvé-Perthes disease |
| Prevention | |
| Treatment | Surgery, physical therapy |
| Medication | Pain management |
| Prognosis | Good with treatment |
| Frequency | 1-10 per 100,000 children per year |
| Deaths | Rare |
Slipped Capital Femoral Epiphysis (SCFE) is a medical condition affecting the hip joint, where the femoral head slips off the neck of the femur at the growth plate. This condition is most commonly seen in adolescents and can lead to significant hip pain and dysfunction if not treated promptly.
Pathophysiology[edit]
SCFE occurs when the growth plate (physis) of the femoral head weakens, allowing the head to slip in relation to the femoral neck. This slippage is typically posterior and inferior. The exact cause of the weakening is not fully understood, but it is believed to be related to hormonal changes during puberty, mechanical stress, and possibly genetic factors.
Epidemiology[edit]
SCFE is most commonly seen in adolescents between the ages of 10 and 16 years. It is more prevalent in males than females and is often associated with obesity. The condition is bilateral in approximately 20-40% of cases.
Clinical Presentation[edit]
Patients with SCFE typically present with hip or knee pain, a limp, and limited range of motion in the affected hip. The pain may be referred to the knee, which can sometimes lead to a delay in diagnosis. On physical examination, there is often limited internal rotation of the hip.
Diagnosis[edit]
The diagnosis of SCFE is primarily made through radiography. Anteroposterior and frog-leg lateral views of the pelvis are typically obtained. The classic radiographic finding is the displacement of the femoral head relative to the femoral neck. The "Klein's line" test can be used to assess for slippage.
Treatment[edit]
The primary treatment for SCFE is surgical stabilization of the femoral head to prevent further slippage. This is typically achieved through in situ pinning, where a single screw is placed across the growth plate. In severe cases, more complex surgical procedures may be required.
Prognosis[edit]
The prognosis for SCFE depends on the severity of the slip and the timeliness of treatment. Early diagnosis and treatment are crucial to prevent complications such as avascular necrosis of the femoral head and osteoarthritis.
Complications[edit]
Potential complications of SCFE include avascular necrosis, chondrolysis, and early onset osteoarthritis. These complications can lead to long-term disability and may require further surgical intervention.
