Slipped Capital Femoral Epiphysis

(SCFE)

Leonel Copeliovitch M.D.“Assaf Harofe Medical Center”

SCFE

Antero-lateral displacement of the femoral neck from the epiphysis

Occurs during adolescent growth spurt

Bilateral in 10 to 80% of cases More common on the left than the

right Affects 1 – 3 per 100,000 people

SCFE

Males: 60%, Females:40% of the cases

Obese child(2/3) or rapidly growing tall adolescent(1/3)

In 5% , parents with SCFE

SCFE- Risk Factors

Physeal height Planar physis Load Abnormal physeal inclination Deficient physeal components

SCFE- disorders associated

Endocrine :cryptorchidism, hypothyroidism, adiposogenital syndrome, acromegaly, growth hormone therapy

Genetic: Kleinfelter, Down, Marfan Metabolic: Rickets, renal

osteodystrophy

SCFE- Pathology

Slip occur between proliferative and hypertrophic zones

Physeal fracture occurs between hypertrophic and calcification zones

SCFE- Clinic

Stable, unstable Limp- Trendelenburg Limitations: abduction, internal

rotation and flexion Pain: groin, thigh or knee Limb shortening: 1 – 2 cm

SCFE- Imaging

X ray: AP, FROG Klein’s line, Capener’s sign Ultra sound Bone scan

SCFE- classification

Acute Chronic Acute on chronic

SCFE- grading

Till 30% 30% to 60% Over 60%

SCFE- treatment

Internal fixation in situ Manipulation and internal fixation Osteotomies: Dunn, Southwick

SCFE- complications

Avascular necrosis (AVN) Chondrolysis Residual deformity Osteoarthritis