Children with a SCFE experience a decrease in their range of motion, and are often unable to complete hip flexion or fully rotate the hip inward. Incidence is rising; there is a trend to it occurring at a younger age and bilateral SCFE is increasing in frequency - all suspected to be related to increasing rates of childhood obesity.
In SCFE, the femoral head of the thighbone slips through the physis, almost the way a scoop of ice cream might slip off a cone. The hip is a ball-and-socket joint, which means that the rounded end of one bone in this case, the "ball" of the thighbone fits into the hollow of another bone the acetabulum, or cup-shaped "socket" of the pelvis.
In most of the cases surgery is necessary to stabilize the hip and prevent the situation from getting worse. Slip Severity Two methods are commonly used to describe the radiographic magnitude of slip severity.
Doctors decide how much weight can be placed on the affected leg after surgery based on the severity of the slip. Surgical Intervention At this time, immediate internal fixation in-situ using a single cannulated screw is the treatment of choice of SCFE.
The severity of the disease can be measured using the Southwick angle. Because some patients have a high risk of an SCFE in the other hip, the surgeon might also stabilize that side too, even if it hasn't slipped yet. It is hypothesized that as weight increases, shearing forces across the physis are also increased, causing it to weaken .
The blood vessels that go to the epiphysis run along the side of the femoral neck and are in real danger of being torn or pinched off if something happens to the growth plate.
Sometimes this happens suddenly — after a fall or sports injury, for example — but often it happens gradually with no prior injury.
A prospective study of fixation with a single screw. In addition, the capital femoral epiphysis is a special one. There is some association with endocrine disorders, such as HypothyroidismHypopituitarism, hupogonadisme and metabolic disorders resulting from the English disease or treatment of chemotherapy or radiation.
The epiphyseal-shaft angle is the angle formed by the intersection of the perpendicular line and the femoral shaft line. The epidemiology of slipped capital femoral epiphysis: In a significant number of cases knee pain is reported as the only symptom.
In a review of the literature, prophylactic treatment may be considered in patients younger than 10 years or patients affected by various endocrinopathies because these individuals have higher relative risks for bilateral involvement. Right The lateral radiograph again shows marked posterior slippage, with remodeling of the anterior metaphysis arrow and formation of callus posteriorly arrowhead.
An unstable SCFE is also more serious because it can restrict blood flow to the hip joint, leading to tissue death in the head of the femur.
Scoring systems have been developed to stratify the risk; generally the younger the child is at presentation, the greater the risk of contralateral SCFE.
Klein's line, the line along the superior aspect of the femoral neck. Mechanical factors in slipped capital femoral epiphysis. A line is drawn between the anterior and posterior tips of the epiphysis at the physeal plate level; then a perpendicular line is drawn to this epiphyseal line.
Doctors will continue to order follow-up X-rays to monitor the condition. SCFE is a shift at the upper part of the thighbone, or femur, that results in a weakened hip joint. Diagnosis[ edit ] The diagnosis is a combination of clinical suspicion plus radiological investigation.
Fixation allows early stabilization of the slippage, enhancement of physeal closure, prevention of further slippage, and amelioration of symptoms with minimal morbidity.
The skeleton also responds by forming callus healing bone at the inferior and posterior portions of the proximal metaphysis in an attempt to structurally buttress the slippage Figure 3.
However, if surgical intervention occurs between 24 and 48 hours, the AVN rate dramatically increases The skeleton also responds by forming callus healing bone at the inferior and posterior portions of the proximal metaphysis in an attempt to structurally buttress the slippage Figure 3.
Wensaas et al evaluated the long-term natural history of untreated contralateral hips to see if there is a consensus regarding prophylactic fixation of the contralateral hip in SCFE.
Ball-and-socket joints offer the greatest range of movement of all types of joints, which explains why we can move our legs forward, backward, and all around.
For the missing item, see the original print version of this publication. Many doctors recommend admission to the hospital as soon as the SCFE is discovered to make sure the patient rests, and so surgery can be done as soon as possible.
The pain and the limp usually tend to come and go, worsening with activity and getting better with rest. SCFE is also more likely in kids who have these risk factors, all of which can affect bone health: There are several classification systems to determine the severity of a SCFE: Sometimes SCFE can irritate the nerves that run down the leg, causing referred pain pain that starts in one part of the body but is felt in another.Slipped Capital Femoral Epiphysis Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and pre-teens who are still growing.
For reasons that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction.
A slipped capital femoral epiphysis occurs when the upper, or capital, epiphysis of the thigh bone (femur) slips sideways off the end of the femur.
(The epiphysis is the end part of the femur. (The epiphysis is the end part of the femur. Slipped Capital Femoral Epiphysis (SCFE) is a condition of the hip that usually affects adolescents, in which the epiphysis (growth plate) of the femur (thighbone) becomes separated from.
Nov 30, · Slipped capital femoral epiphysis (SCFE) is one of the most important pediatric and adolescent hip disorders encountered in medical practice. Although SCFE is a rare condition, an accurate diagnosis combined with immediate treatment is critical.
Definition: Slipped Capital Femoral Epiphysis (SCFE), also known as Slipped Upper Femoral Epiphysis (SUFE), is characterized by a displacement of the capital femoral epiphysis from the femoral neck through the physeal plate.
Epidemiology. Incidence: 1/ and 1/10, (Kelsey ). A slipped capital femoral epiphysis can cause problems with a decrease in blood flow to the head of the Femur, resulting in avascular necrosis (bone death) and so should be addressed as soon as possible.
Treatment of a slipped capital femoral epiphysis.Download