Slipped capital femoral epiphysis

The diagnosis of subtle slipped capital femoral epiphysis (SCFE), for example in the contralateral asymptomatic hip, may require use of an exactly defined and reproducible lateral view where the slipping angle can be measured. To test a simplified geometrical method and compare it to the conventional method (AP and frogleg views). The two methods were compared in 95 normal children 9-14 years old and 100 children 9-20 years old with SCFE. The slipping angle (SA) measurements had very high reproducibility, and the new method was diagnostically superior to the conventional method ( P<0.05). An exactly defined and reproducible lateral view is recommended for the X-ray diagnosis of SCFE. Nontraumatic SCFE appears to be bilateral in all cases.

The surgical dislocation approach is useful in assessing and treating proximal femoral hip deformities commonly due to pediatric conditions. We sought to demonstrate the efficacy and problems associated with this technique. Diagnoses included slipped capital femoral epiphysis, Perthes disease, developmental dysplasia of the hip, osteonecrosis, and exostoses. Through this approach, femoral head-neck osteoplasty (22), intertrochanteric osteotomy (eight), femoral head-neck osteoplasty plus intertrochanteric osteotomy (15), femoral neck osteotomy (five), open reduction and internal fixation of an acute slipped capital femoral epiphysis with callus resection (five), open reduction and internal fixation of an acetabular fracture (one), trapdoor procedure (one), and acetabular rim osteoplasty (one) were performed. The average patient age was 16 years. The minimum followup was 12 months (average, 41.6 months; range, 12–73 months). Patients with Perthes disease and SCFE had preoperative and postoperative WOMAC scores of 9.6 and 5.1, and 7.9 and 3.5 respectively. In patients with unstable SCFEs, the average postoperative WOMAC score was 1.2. Seven patients underwent THAs and two patients underwent hip fusion. Complications in the 58 procedures included four cases of osteonecrosis: three after femoral neck osteotomy and one after intertrochanteric osteotomy. The surgical dislocation technique can be utilized to effectively treat these deformities and improve short-term symptoms. Although the technique is demanding, we believe surgical dislocation offers sufficient advantages in assessing and treating these complex deformities that it justifies judicious application. Level of Evidence: Level IV, retrospective study, case series. See the Guidelines for Authors for a complete description of levels of evidence.

The authors report two cases of bone disorders in children with short stature, with confirmed growth hormone (GH) deficiency treated by GH supplementation. The first patient, aged 15 years, developed avascular necrosis of the femoral head and scoliosis. The second one, aged 17 years, had avascular necrosis of the femoral capital epiphysis on one side and acute slipped capital femoral epiphysis (SCFE) on the other side. All these complications were diagnosed while they were receiving GH-therapy. The exact aetiology and the role of GH in the pathogenesis of these conditions are still unknown.

ObjectivesThe aim of this study were (1) to evaluate the incidence of apparent missed diagnosis of slipped capital femoral epiphysis (SCFE) by the primary care system and (2) to identify possible factors leading to a delay in diagnosis of this disorder.Setting and DesignA retrospective review of emergency department records, outside medical charts, and preoperative and postoperative radiographs of children treated surgically for SCFE at the Children’s Hospital of Los Angeles (CHLA) from 1989 to 1997 was done to assess the delay in diagnosis for SCFE. The primary care system included outside emergency department visits, urgent care clinic visits, and private office visits.ResultsOf 102 patients (69 men, 33 women; mean age at surgery, 11.9 years), 68% were above the 95th percentile mean weight for age. Pain in the hip and/or groin was documented in 60%. The mean duration of symptoms experienced before being seen at CHLA was 140 days (hours to 1.5 years) and the mean delay after the first primary care visit till being seen at CHLA was 76 days (hours to 1 year). Fifty-two percent of primary care visits for hip, groin, knee, or thigh pain in obese children did not lead to either a diagnosis of SCFE or a referral for orthopedic evaluation.ConclusionsThis study documents a 2 1/2-month delay and a 52% incidence of apparent missed diagnosis for SCFE by the primary care system. There seems to be a need for increased orthopedic education for primary care providers.

ABSTRACT: The use of cannulated screws for internal fixation of slipped capital femoral epiphysis (SCFE) is recognized as the standard method of treatment and has fewer complications compared with previous methods such as pins or tri-flanged nails. Some ...

The prevalence of asymptomatic cardiac valve anomalies was determined in 82 patients (69 females and 13 males) diagnosed as having idiopathic scoliosis and scheduled for corrective surgery (mean age at surgery 16.3 years). The preoperative study in each patient included echocardiography and ultrasound Doppler. Twenty-three valvular anomalies were found in 20 patients (24.4%). The most frequent was mitral valve prolapse. The occurrence of valvular anomalies did not correlate with sex, curve magnitude, or age at diagnosis. Eighteen patients presented a total of 20 comorbid conditions: positive family history of scoliosis (five cases), isthmic spondylolisthesis (five cases), nervous anorexia (two cases), hereditary exostosis, cystic fibrosis, ureteral stenosis, mammary hypoplasia, slipped capital femoral epiphysis, psoriasis, celiac disease, and lactose intolerance. A significant relationship was found between valvular anomalies and comorbidity. Valvular anomalies were detected in 11 out of 64 patients (17.2%) with no comorbidity and in nine out of 18 patients (50%) with a comorbid condition (Chi-square 8.2, p = 0.004). In this latter group of patients, routine echocardiographic study seems advisable in the preoperative evaluation.

Slipped capital femoral epiphysis (SCFE) is an adolescent disorder that is characterized by slipping of the femoral head off the femoral neck. It is classified into acute, chronic, and acute on chronic types. This study examines not only the epidemiology and classification, but also the etiology and pathogenesis of SCFE. Recent studies imply that obesity, trauma, shear stress in growth plate, and hormonal disturbances are some of the contributing factors to SCFE. More studies will reveal the pathophysiological mechanisms of this multifactorial disorder that concerns both pediatrics and orthopedics.

Slipped capital femoral epiphysis (SCFE) is a common adolescent problem in the western populations but it is extremely rare in the Asian regions. We report a case management of a teen age boy (16 years old at the time of operation) with bilateral SCFE. After fall injury, the boy sustained SCFE on the left side and was treated. Again after six months with trivial injury he got SCFE on the right side. In both cases the boy was managed by closed reduction and percutaneous cannulated cancelleous screws fixation under c-arm fluoroscopy control. The cannulated screws were removed after one year of insertion confirming of a good fusion in plain x-ray films. During the regular follow up of up to one year the patient had good hip functions and other daily activities. The patient lost to follow up for about three years and suddenly presented to us with restricted hip joints movements and other activities. The x-ray showed tilted pelvis, reduced, incongruent hip joint spaces with malunited fem...

Objective. Delay in diagnosis of slipped capital femoral epiphysis (SCFE) has important implications in terms of slip severity and long-term hip outcome. The purpose of this study was to identify predictors of delay in the diagnosis of SCFE. Methods. A review of 196 patients with SCFE was performed. The primary outcome measure was delay from onset of symptoms to diagnosis. Covariates included age, gender, side, weight, pain location, insurance status, family income, slip severity, and slip stability. Delay in diagnosis was not normal in distribution; therefore, nonparametric univariate and multivariate analyses were performed. Results. The median delay in diagnosis was 8.0 weeks. There was a significant relationship between delay in diagnosis and slip severity (<30°: 10.0 weeks; 30° to 50°: 14.4 weeks; >50°: 20.6 weeks). There were no significant associations between delay in diagnosis and covariates of age, gender, side, and weight. There were significant associations between...

Objective: To assess the importance of using conventional
magnetic resonance imaging and T2 mapping to determine
the pre-slip stage of the contralateral epiphysis in patients
with a clinical and radiographic diagnosis of unilateral
proximal femoral epiphysiolysis who were initially treated
with in-situ fixation. Methods: This prospective clinical
study on 11 patients with unilateral epiphysiolysis
was conducted between February 2009 and August 2010, using magnetic resonance imaging on the contralateral
hip. Results: We observed abnormalities in the proximal
femoral capital physis of the contralateral unaffected hip,
with edema under the growth plate in 27% of the patients
assessed. Conclusion: Magnetic resonance imaging is an
early and sensitive method for detecting the pre-slip stage
of the proximal femoral epiphysis.