Slipped capital femoral epiphysis (SCFE)?

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Slipped capital femoral epiphysis (SCFE)?
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SCFE

• Posterior and Medial displacement of the femoral
  capital epiphysis on the femoral neck through
  sudden or gradual deformation of the sub-capital
  growth plate

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Incidence

• 3/100,000 in whites
• 7/100,000 in blacks
• Age
• Males 12-16 years
• Females 10-14 years
• M-F 2,4-1
• LgtR, bilateral in 25

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Etiology

• Mechanical overload due to obesity, decreased
  anteversion, changes within physeal plate
• Inflammatory synovial inflammation?
• Hormonal obesity, hypogonadal features in boys,
  secondary and primary hypothyroidism,
  panhypopituarism, hypogonadal conditions, renal
  osteodystrophy, growth hormone therapy
• Trauma

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Predispositions

• Obesity
• Rapid growth
• Endocrinopathies
• Hypothyroidism
• Renal osteodystrophy
• Pituitary deficiency
• GH deficiency when treated with GH as this causes
  rapid growth

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Symptoms

• Limp
• Pain
• Groin
• Femur
• Knee
• Lateral rotation aggravated when hip is flexed
• Decreased internal rotation

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(No Transcript)
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Classification

• Acute slip sudden, severe, fracture-like pain
  in the upper thigh after trauma
• Chronic slip a few months history of vague pain
  in the groin, upper thigh and limp
• Acute on chronic slip prodromal symptoms with
  exacerbation of pain

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Classification

• 0 pre slip
• I lt30º (mild slip)?
• II 30º 60º (moderate slip)?
• a 30º - 40º
• b 40º - 50º
• c 50º - 60º
• III - gt60º (severe slip)?

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Head-neck angle
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Southwick- head-shaft angle
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Classification - Loder
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Kleins Line
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Radiographs
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Treatment

• Stabilisation of epiphysis and prevention of
  further slippage
• Stimulation of physeal plate arrest
• Functional improvement by restoration anatomy in
  severe cases

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Treatment

• 0 and I in situ stabilization
• II - in situ stabilization or inter- ,
  subtrochanteric femoral osteotomy
• III subcapital femoral neck osteotomy, inter- ,
  subtrochanteric femoral osteotomy

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Stabilisation
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Stabilisation
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Stabilisation
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Prognosis

• The majority of patients will be able to return
  to most sports and activities at approximately
  3-6 months post-operatively.
• Removing the hardware is not necessary unless the
  patient develops pain or there is a problem with
  the screw itself.
• Because of the high association of bilaterality
  seen in SCFE (approx 25-40), patients will need
  to be closely monitored to ensure that the
  contralateral hip does not slip.

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• IRRITABLE HIP
• (observation hip, toxic synovitis, transitory
  coxitis, coxitis serosa, coxalgia fugax, phantom
  hip, transient synovitis)?

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Epidemiology

• Most common cause of hip pain
• Reported incidence is 1 in 1000
• From 9 months to adolescence (usually between age
  3 and 8 yrs -peak age is 6 yrs)?
• More common in boys (21)?
• Whites
• Never bilateral

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Etiology

• Bacterial/viral infection
• Trauma
• Allergic reaction

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Natural history

• Limited duration of symptoms (average 10 days-
  may be as long as 8 weeks)?
• Recurrence uncommon (lt 10)?
• May be mild radiographic changes in hip
• Coxa magna and femoral neck widening
• Association with perthes disease in 1.5

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Symptoms

• Acute hip pain (thigh, groin or knee)
• Limp with or without pain
• Stance phase shorter for affected limb
• Slightly raised temperature
• Hip held in flexion, external rotation and
  abduction
• Protective muscle spasm
• One side affected

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Diagnosis

• Clinical examination
• USG- may show effusion
• Rtg- usually normal
• Laboratory- may be mild elevation of WBC, ESR
  (OB)gt20

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Differential diagnosis

• Perthes disease
• Septic arthritis
• Osteomyelitis
• Juvenile rhemoatoid arthritis
• Slipped femoral epiphysis

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Treatment

• Bed rest and analgesia until full ROM achieved
• Non-weight-bearing
• Traction only for severe cases
• NSAIDs- Naproxen 10mg/kg/d
• Partial weight bearing on crutches until limp
  resolves