Slipped Capital Femoral Epiphysis
(SCFE)
Leonel Copeliovitch M.D.“Assaf Harofe Medical Center”
SCFE
Antero-lateral displacement of the femoral neck from the epiphysis
Occurs during adolescent growth spurt
Bilateral in 10 to 80% of cases More common on the left than the
right Affects 1 – 3 per 100,000 people
SCFE
Males: 60%, Females:40% of the cases
Obese child(2/3) or rapidly growing tall adolescent(1/3)
In 5% , parents with SCFE
SCFE- Risk Factors
Physeal height Planar physis Load Abnormal physeal inclination Deficient physeal components
SCFE- disorders associated
Endocrine :cryptorchidism, hypothyroidism, adiposogenital syndrome, acromegaly, growth hormone therapy
Genetic: Kleinfelter, Down, Marfan Metabolic: Rickets, renal
osteodystrophy
SCFE- Pathology
Slip occur between proliferative and hypertrophic zones
Physeal fracture occurs between hypertrophic and calcification zones
SCFE- Clinic
Stable, unstable Limp- Trendelenburg Limitations: abduction, internal
rotation and flexion Pain: groin, thigh or knee Limb shortening: 1 – 2 cm
SCFE- Imaging
X ray: AP, FROG Klein’s line, Capener’s sign Ultra sound Bone scan
SCFE- classification
Acute Chronic Acute on chronic
SCFE- grading
Till 30% 30% to 60% Over 60%
SCFE- treatment
Internal fixation in situ Manipulation and internal fixation Osteotomies: Dunn, Southwick
SCFE- complications
Avascular necrosis (AVN) Chondrolysis Residual deformity Osteoarthritis