Pediatric Orthopedics

Slipped Capital Femoral Epiphysis (SCFE)

slipped capital femoral epiphysis

Slipped capital femoral epiphysis

Slipped epiphysis is a disease of the femoral head. Basically, femoral epiphysis displaces on the growth plate. Hence, it is called as slipped capital  femoral epiphysis

What is the frequency slipped capital femoral epiphysis?

The incidence of the disease is, 8-13/100.000. It is more common in blacks and Hispanics. Male / female ratio is 2.4. More frequently observed on the left. 20-40% of the patients had chronic bilateral involvement. If the symptoms are seen less than 3 weeks, it is called as acute, and chronic if the symptoms are seen more then 3 weeks. When an exacerbation is seen  in a long standing scfe case, It is called acute on chronic.

What causes the disease?

The disease is more common in the growing teens between 10 and 16 ages. Obese Patients more risk. Because, shear forces acting on the growth plate increased with increasing weight. Hypothyroidism, growth hormone disorders, hypogonadism  are more commonly diagnosed among children with SCFE. Slipped capital femoral epiphysis (SCFE) diagnosis in a child younger 10 years or over 16 years of age requires endocrine work up.

What are the clinical signs?

The typical patient, adolescence, overweight male patient who often presents with sudden onset of hip pain. He/she walks with  the foot rotated outward and  coupled with limping usually . On Physical examination, hip flexion and internal rotation ranges are reduced while  hip extension, and external rotation ranges are increased. Ipsilateral extremity shows 1-2 cm shortening.

What are the radiological findings of shifting capital femoral epiphysis?

On Anterior-posterior radiographs of the pelvis, femoral head epiphysis slip classified as

I-mild  slip: up to 1/3 of epiphysis

II-moderate:  1/3-2/3 of epiphysis is displaced

III-severe: 2/3 more than slip.

On Lateral hip radiographs, or frog-leg position, the angular deviation of epiphysis is measured. Accordingly, the I-mild: slip showing less than 30 degrees of angulation, II-moderate: slip of 30 to 60 degrees, III-severe: when the angle is more than 60 degrees.

What is the treatment of slipped capital femoral epiphysis?

Acute Slipped capital femoral epiphysis requires urgent surgical treatment. Either Gentle reduction can be tried or in situ pinning without reduction may be performed depending of surgeon’s choice. Usually one cannulated screw is used in internal fixation.






About the author

Prof.Dr. Seref Aktas