SCFE (Slipped Capital Femoral Epiphysis) Flashcards
What is slipped capital femoral epiphysis (SCFE)?
Disorder of the proximal femoral physis that leads to slippage of the epiphysis relative to the femoral neck
Stability of SCFE based on whether they can bear weight (low risk of osteonecrosis
What are the demographics for SCFE?
1) obese children (single greatest risk factor)
2) males (male to female ratio is 3:2)
3) African Americans
4) Pacific islanders
5) during period of rapid growth (males 13.2 yo, females 12.2 yo)
Left hip is more common; bilateral in 17-50%
What area of the physis does SCFE occur?
Hypertrophic zone; cause by weakness of the perichondral ring
epiphysis displaces posteriorly
How does SCFE present?
1) Thigh or groin pain
2) Can present with knee pain (15-23%)
3) Loss of hip internal rotation, abduction and flexion
What is Klein’s line?
On an AP pelvis a line drawn along superior edge of femoral neck should intersect with femoral head
Will not in SCFE with a slip
What are common endocrine conditions a/w SCFE?
1) hypothyroidism (low TSH)
2) renal ostedystrophy (abnormal BUN and Cr)
3) growth hormone treatment
Endocrine workup indicated in pts presenting less than 10yo or less than 50th percentile for weight
How are SCFEs treated?
In situ perc pinning
Contralateral prophylactic pinning indicated in high risk pts (obese, hypothyroid, age
What technical points are important with in situ pinning of SCFE hips?
1) no reduction needed
2) pins started anteriorly
3) 3 threads must cross physis
4) screws should be
What is the most common complication after unilateral surgical fixation of a SCFE hip?
Contralateral SCFE in 20-80%; higher risk in males, obese, endocrine disorders, young age of initial slip
What is the rate of osteonecrosis of high grade SCFE slips?
40-50%
Can also occur with surgical fixation if screw is placed in posterosuperior femoral neck
Southwick angle (epiphyseal-shaft angle) serves what purpose in the evaluation of a slipped capital femoral epiphysis (SCFE)?
Determines the severity of the slip
Measured on frog-leg lateral; epiphysis- shaft angle compared to other side and graded from mild 50°
What is the most common limb length and rotational profile found as a sequelae of SCFE?
Limb shortening, decreased hip flexion and decreased hip internal rotation
In a patient with delayed presentation of SCFE that has restricted hip flexion motion, an external rotation deformity, and obligatory external rotation upon hip flexion manuevering, what osteotomy is most appropriate?
Flexion, internal rotation, and valgus-producing proximal femoral osteotomy (Imhauser osteotomy)
What is the most common displacement for SCFE and how does this impact screw starting point?
neck displacing anteriorly while the epiphysis stays within the acetabulum. For in situ fixation, the screw must start on the anterior surface of the neck in order to cross the physis perpendicularly, and enter the epiphysis
