• Clinical science

Slipped capital femoral epiphysis (Juvenile femoral head detachment…)

Abstract

Slipped capital femoral epiphysis (SCFE) refers to the posterior and inferior displacement of the femoral head in relation to the femoral neck at the proximal femoral growth plate. It occurs most commonly in adolescent males. While the etiology is not entirely understood, multiple risk factors such as obesity and endocrine disorders have been identified. SCFE may have an acute or insidious onset, with hip pain, limping, and restricted movement of the affected hip. If the patient is unable to walk then the SCFE is considered unstable, which increases the risk of complications such as avascular necrosis. Conventional x-ray confirms the displacement. Surgical fixation of the femoral head is the only treatment.

Epidemiology

  • Most common hip disorder in adolescents
  • Peak incidence: 10–16 years (often occurs during a growth spurt)
  • Sex: >

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References: [1][2][3]

Pathophysiology

References:[2]

Clinical features

  • Acute, chronic (3 weeks to several months), or acute on chronic (chronic with acute exacerbations) onset
  • Dull pain in the medial thigh, knee , groin, or hip pain (often left > right)
  • Sudden limp
  • Restricted range of motion
    • Reduced internal rotation and abduction
    • Patients may hold their hip in passive external rotation
    • Drehmann sign positive; : external rotation and abduction during passive flexion of the affected hip in supine position
  • Bilateral in ∼ 40% of cases
  • SCFE may be stable or unstable
    • Stable SCFE (∼ 90%): able to bear weight on affected hip, with or without crutches
    • Unstable SCFE (∼ 10%) : inability to ambulate and bear weight on affected hip, even with crutches

References: [1][2][3]

Diagnostics

  • Confirmatory test: x-ray
    • Findings
      • Widening of the joint space
      • The femoral head is displaced posteriorly and inferiorly in relation to the femoral neck.
      • Frog leg projection (supine position, flexion of 45° and abduction of 45° in the hip)
        • Allows for better evaluation of the femoral head and neck
      • A Klein line that does not pass the femoral head
      • The frog leg projection line that does not pass the femoral head
      • Southwick method (for measurement of the slip angle/severity)
    • Rules out underlying medical conditions (e.g., rickets)
    • Determines degree of displacement
      • Type I: < 33% displacement
      • Type II: 33–50% displacement
      • Type III: > 50% displacement
  • Consider laboratory tests to exclude endocrinopathies in patients with an atypical age of onset or short stature.

References:[2]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

  • Avoid weight bearing before stabilization
  • Urgent surgical internal fixation with pinning of the femoral head
  • Prophylactic fixation of the contralateral hip
  • Fixation by K-wires if slipping angle < 30°
  • Possibly correction by Imhauser's osteotomy if slipping angle > 30°

References:[1][2][3]

Complications

References: [1][2]

We list the most important complications. The selection is not exhaustive.

last updated 10/18/2018
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