Slipped capital femoral epiphysis

Slipped Capital

Femoral

Epiphysis Dr. Fahad Al Hulaibi 2015

Orthopedic Surgery

National Guard Hospital-KSA

OPD PIC.

What is SCFE ?? Disorder of:

proximal femoral physis

that leads to slippage of the epiphysis

relative to the femoral neck

Risk factors

obese children

Males

Age 10-16 y/o Campbell

+ve family history

Endocrinopathy. < 10 y/o

Lt. hip is more common Campbell

In which zone of physis ?

Causes: local trauma.

inflammatory conditions.

Endocrine disorders (e.g., hypothyroidism, hypogonadisim, hypopituitarism, and chronic renal disease)

genetic factors,

Down syndrome

It is a multifactorial

presentation

Boy : Girl ( 2:1 ) Campbell

Knee pain (15-23%), thigh or groin pain.

Limping. (if stable)

symptoms usually for weeks to several

months.

Thigh atrophy.

obligatory external rotation

X-ray Finding

AP & frog lateral

Klein's line

Dr. saleem patient

blurring of proximal femoral metaphysis

epiphyseal plate seems to be too wide

and too ‘lucent’

“blanch” sign

CT

Do we need CT ?

Classifications

Stability by Loder et al.

Stable:

can bear weight

Un-stable

can’t bear Wight >> 47% ? AVN

Chronicity Campbell

Acute:

Symptoms < 2 weeks

Chronic:

Symptoms > 2 weeks

Acute on chronic:

> 4 weeks with recent sudden exacerbation

Southwick Angle Classification

Mild:

< 30 °

Moderate:

30 ° - 60 °

Severe:

> 60 °

Head shaft angle

In frog lateral view

Grading System Campbell

Grade I :

0-33 % of slippage

Grade II :

30-50 % of slippage

Grade III :

> 50 % of slippage

TREATMENT

percutaneous in situ fixation

In all stable and unstable slip.

Goal:

- To stabilize the epiphysis from further slippage.

- Avoiding the complications.

One screw or 2 ??

POSTOPERATIVE CARE

discharged the same day.

partial weight-bearing crutch (2 to 3 wks)

for stable only

rigorous sports limited until the physes

have closed.

Screw removal is not necessary.

contralateral in situ

prophylactic pinning ??

If one side affected..

25-40% the other one will be

Benson EC, Miller M, Bosch P, Szalay EA. A new look at the incidence of slipped capital femoral epiphysis

in new Mexico. J Pediatr Orthop. 2008 Jul-Aug. 28(5):529-33

12 to 18 months of the initial slip

increased incidence

Endocrine abnormalities

Age < 10 y/o

for whom reliable follow-up is not feasible.

high risk factors for complications.

“posterior sloping” angle of more than 12

degrees

CLOSED REDUCTION

slips treated without reduction.

Only sever unstable acute Slip.

OPEN REDUCTION

if a severe acute or chronic slip cannot be

reduced closed.

OSTEOTOMY

COMPLICATIONS

COMPLICATIONS

OSTEONECROSIS

Common in unstable.

Superolateral placement of pins

CHONDROLYSIS

a joint space less than 3 mm wide

(normal 4 to 6 mm)

decreased range of motion of the hip joint

Most serous complication.

Most painful.

End with Ankylosis of hip joint.

Tx: ??

FEMORAL NECK FRACTURE

Message is:

avoiding drilling

unnecessary

holes in the bone

during surgery

CONTINUED SLIPPING

Patients who refused treatment.

Pins were not placed far enough proximally.

Remove pins before the physis had fused

completely

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