Slipped Capital Femoral Epiphysis (SCFE)
Term Slipped Capital Femoral Epiphysis is a misnomer.
The femoral epiphysis maintains its normal relationship within the acetabulum, and it is the femoral neck and shaft that displace relative to the femoral epiphysis and the acetabulum.
The usual deformity consists of an upward and anterior movement of the femoral neck on the capital epiphysis.
Unknown in the vast majority of patients, but mechanical and endocrine factors are thought to play a role.
Mechanical factors include thinning of the perichondrial ring complex, Relative or absolute retroversion of the femoral neck, and a change in the inclination of the adolescent proximal femoral physis relative to the femoral neck and shaft.
Endocrine factors include adiposogenital syndrome, hypothyroidism, chronic renal failure, abnormalities treated by growth hormone administration. Rare causes include prior pelvic irradiation, Rubinstein-Taybi syndrome, Klinefelter’s syndrome, primary hyperparathyroidism, panhypopituitarism, etc.
Clinical features depend on the type of SCFE and vary accordingly to whether the symptoms are chronic, acute-on-chronic, or acute; whether the slip is stable or unstable; with the severity of the resultant deformity; and with the co-existence of the complication of AVN or chondrolysis.
A stable chronic slipped capital femoral epiphysis child usually presents with groin pain, which may be referred to as the anteromedial aspect of the thigh and knee.
On examination, there will be a loss of internal rotation with increased hip extension and external rotation. There may be a shortening of the affected extremity by 1 to 2 cm.
Unstable acute or acute on chronic slipped capital femoral epiphysis characteristically presents with sudden onset of severe, fracture like pain in the affected hip region, usually as the result of a relatively minor fall or twisting injury.
A patient usually lies with the affected limb in external rotation and refuses to move the hip.
Chondrolysis complicating slipped capital femoral epiphysis presents with a history of more continuous pain and greater interference with daily activities because of the loss of hip joint range of motion.
On examination, the affected hip is held in an externally rotated position at rest, with flexion contracture and global restriction of hip motion.
Plain radiography in anteroposterior and lateral views of the pelvis is the primary and often the only imaging modality needed to evaluate slipped epiphysis.
Other imaging includes computed tomography, bone scan, PET scan, and magnetic resonance imaging.
Treatment depends on the severity of slipped capital femoral epiphysis.
Mild to moderate slipped capital femoral epiphysis is managed within situ pinning. And at later date, this patient may need arthroscopic anterolateral bumpectomy.
The severe slipped capital femoral epiphysis is managed with modified Dunn’s procedure with a safe surgical hip dislocation approach.
Long term consequences depend on the type of slipped capital femoral epiphysis and on the treatment approach used.
Uncomplicated cases with mild to moderate slips should lead a normal life.
Complicated and neglected cases will develop early arthritis of the hip joint.