• Clinical science

Slipped capital femoral epiphysis (Juvenile femoral head detachment…)

Summary

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

Epidemiological data refers to the US, unless otherwise specified.

Etiology

The exact etiology is still unknown. However, there are some risk factors that increase the likelihood of SCFE: [2]

Pathophysiology

To visualize the displacement of the femoral head in slipped capital femoral epiphysis, imagine a scoop of ice cream that slips from its cone.

Clinical features

Diagnostics

  • Imaging [5][1]
    • Modality
    • Findings
      • Widening of the joint space
      • The femoral head is displaced posteriorly and inferiorly in relation to the femoral neck.
      • Klein line not passing the femoral head: It is a straight line drawn along the superior border of the femoral neck that normally passes through the femoral head.
      • Frog leg projection line not passing the femoral head: It is a line drawn through the center of the epiphysis that normally should pass through the center of the femoral neck.
      • Southwick method (for measurement of the slip angle/severity): refers to the tilt of the femoral neck in relation to the femoral head
      • Rules out underlying medical conditions (e.g., rickets)
      • Determines degree of displacement
  • Laboratory tests: to exclude endocrinopathies in patients with an atypical age of onset or short stature

Treatment

  • Avoid weight bearing before stabilization [5][1]
  • Urgent surgical internal fixation with pinning of the femoral head
  • Prophylactic fixation of the contralateral hip

Differential diagnoses

Snapping hip syndrome [6]

  • Definition: : snapping of the iliotibial band or gluteus maximus over the greater trochanter (external), or snapping of the iliopsoas tendon over the iliopectineal eminence (internal), typically seen in young athletes and dancers
  • Epidemiology
    • Sex: >
    • Peak incidence: 15–40 years
  • Clinical features
  • Treatment
    • Physical therapy, rest, ice
    • Injection of local anesthetic
    • If complaints persist: surgical treatment

The differential diagnoses listed here are not exhaustive.

Complications

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

  • 1. Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped Capital Femoral Epiphysis: Current Concepts. J Am Acad Orthop Surg. 2006; 14(12): pp. 666–679. doi: 10.5435/00124635-200611000-00010.
  • 2. Perry DC, Metcalfe D, Lane S, Turner S. Childhood Obesity and Slipped Capital Femoral Epiphysis. Pediatrics. 2018; 142(5): p. e20181067. doi: 10.1542/peds.2018-1067.
  • 3. Leunig M, Casillas MM, Hamlet M, et al. Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000; 71(4): pp. 370–375. doi: 10.1080/000164700317393367.
  • 4. Riad J, Bajelidze G, Gabos PG. Bilateral Slipped Capital Femoral Epiphysis. Journal of Pediatric Orthopaedics. 2007; 27(4): pp. 411–414. doi: 10.1097/01.bpb.0000271325.33739.86.
  • 5. Peck D. Slipped Capital Femoral Epiphysis: Diagnosis and Management. Am Fam Physician. 2010; 82(3): pp. 258–262. url: http://www.aafp.org/afp/2010/0801/p258.html#sec-1.
  • 6. Piechota M, Maczuch J, et al. Zespół trzaskającego biodra w dynamicznym badaniu ultrasonograficznym. Journal of Ultrasonography. 2016; 16(66): pp. 296–303. doi: 10.15557/jou.2016.0030.
last updated 11/04/2020
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