slipped capital femoral epiphysis
- related: Pediatric
SCFE
- pt: overweight adolescents, AA, hypothyroidism, down syndrome, or thin pt with rapid growth spurt
- cause:
- slippage of epiphysis relative to metaphysis at growth plate
- Cartilage in the hypertrophic zone acts as the weak point where the slippage occurs.
- symptoms:
- presents with a limp. Pain when moving hips
- thigh and groin pain, knee pain
- Trendelenburg gait
- external rotation in passive hip flexion (limited hip flexion)
- limited hip internal rotation and abduction
- dx:
- xray: AP and frog leg showing the epiphysis remaining within the acetabulum while the neck displaces anteriorly and externally rotates leaving the head posterior to the neck. An early radiographic finding is epiphysiolysis where the growth plate is widened or shows increased lucency
Treatment
Treatment options are primarily surgical with percutaneous pinning of the slipped side. Treatment of this condition is emergent.
Prophylactic pinning of the non-slipped side should be considered in cases of slipped capital femoral epiphysis related to hypothyroidism.
Complications of slipped capital femoral epiphysis include avascular necrosis, chondrolysis, and premature osteoarthritis.
frog leg xray:
| Dz | Age | Symptoms | Diagnosis | Treatment |
|---|---|---|---|---|
| DDH | Newborn | clicky hip | US at 4 wks | Harness to line up joints |
| LCP | 6 yo | Slow onset, antalgic gait | Xray | Cast |
| SCFE | 13 yo | growth spurt, fat. Nontraumatic joint pain. | Frog-leg xray | Surgery |
| SJ | Any | fever, leukocytosis, ESR, CRP, can't bear weight. Pain with movement of leg. Osteomyelits has focal pain. | Arthrocentesis > 50k WBC | IND, Abx |
| TS | Any | Hip pain, weeks after viral, can't bear weight. | Clx | Supportive |