Slipped Capital Femoral Epiphysis (SCFE) (subtitled)

Slipped Capital Femoral Epiphysis:
Slipped capital femoral epiphysis (SCFE) is a disorder of adolescents
in which the growth plate is damaged and the femoral head slips down and backward off the neck of the bone at the growth plate.
In unilateral slips, SCFE may happen in contralateral (normal) hips within 18 months from the time of the initial episode.
Typically, SCFE occurs in overweight children between 11 and 16 years old and is more common in boys than girls.
Obesity is a major risk factor.
may be a genetic.
It can also occur due to a fall or other injury, particularly in acute and acute-on-chronic slips.
Children with SCFE who are younger than 10 years, older than 16 years, are likely to have one of these risk factors.
renal failure,
radiation therapy,
endocrine abnormalities
(particularly hypothyroidism and growth hormone deficiency),
or genetic disorders (eg, Down syndrome).
SCFE is traditionally classified into four patterns of presentation on the basis of intensity and duration of symptoms:
Preslip:
Children with preslip SCFE have pain but no discernible displacement of the epiphysis.
The patient may also present a slight or mild limp,
Acute slips:
Children with acute SCFE have symptoms of less than three weeks' duration.
Symptoms include onset of severe pain,
external rotational deformity,
limited range of motion of the hip,
shortening,
and commonly, inability to bear weight.
the patient complains of intense pain with any attempt at passive motion.
Acute-on-chronic slips:
The acute-on-chronic presentation occurs when a patient with a history of symptoms and signs of chronic SCFE
(eg, limp and or pain of at least three weeks’ duration)
presents with an acute increase in pain and loss of motion of the affected hip.
Chronic slips:
It is characterized by vague, intermittent symptoms over a protracted period, usually considered to be longer than three weeks.
The classic presentation is a complaint of a dull, aching pain in the hip, groin, thigh, or knee and no history of preceding trauma .
The pain may be chronic or intermittent;
it is increased by physical activity and relieved with rest.
The affected leg is usually held in an externally rotated position
and may be shorter than the unaffected leg.
he may also present a slight or mild limp.
Antalgic gait:
Trendelenburg gait:
Waddling gait.
Stable slips are defined as those in which walking and weightbearing are possible with or without crutches.
Unstable slips are those in which the epiphysis is displaced from the metaphysis
or the patient is unable to bear weight, even with crutches, regardless of duration of symptoms.
Most of these patients present with severe pain similar to a fracture of the hip.
the method of grading slip severity is according to the epiphyseal-shaft angle of Southwick,
which is measured on the frog-leg lateral radiograph.
Mild slips have less than 30 degrees of displacement.
Moderate slips have between 30 and 50 degrees.
Severe slips have greater than 50 degrees of displacement compared with the unaffected side.
Physical examination may demonstrate hip pain on palpation
and limitation of hip range of motion, especially internal rotation and flexion.
the diagnosis of SCFE usually is made based upon plain radiographs.
In the normal anteroposterior view,
a line drawn along the superior femoral neck (Klein's line) intersects the lateral portion of the femoral head.
In a patient with SCFE, the line passes outside of the epiphysis or just at its superior edge.
The posterior displacement and step-off of the epiphysis on the femoral neck are better demonstrated on the lateral view.
The lateral projections are obtained by the frog-leg
or true lateral hip radiographs (The cross-table view);
true lateral hip radiographs (The cross-table view) is recommended in patients who have acute slips,
since the flexion and abduction of the hip that is necessary for the frog-leg view may displace the physis in these unstable slips.
If the radiograph is normal but suspicion for early SCFE is high,
the doctor will refer the patient for MRI.
we recommend screening T4, TSH, and bone age and evaluation for kidney disease for those patients who have atypical SCFE:
(Younger than 10 years, Older than 16 years, short stature).

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