Slipped Capital Femoral Epiphysis

1. See Also
   1. Pediatric Limp
2. Epidemiology
   1. Occurs during maximal pubertal growth spurt
      1. Males: age 14 to 16 years
      2. Females: age 11 to 13 years
   2. Most common adolescent hip disorder
      1. Incidence: 1 to 4 per 100,000
   3. Black race affected more often than white race
   4. Unilateral involvement in 90% of cases
   5. Child is often Overweight or obese
3. Risk Factors: Younger onset or atypical cases
   1. Arthritis
   2. Endocrinopathy
   3. Renal Failure
   4. Radiation Therapy
   5. Chemotherapy
4. Pathophysiology
   1. Occurs before the epiphyseal plate closes
5. Symptoms
   1. Hip Pain with indolent course
   2. Pain may be referrred to knee
6. Signs
   1. Hip held in abduction and external rotation
   2. Markedly limited internal rotation
7. Imaging
   1. Hip XRay (Compare sides)
      1. Widened epiphyseal plate
      2. Displacement of femoral head
      3. Draw line down the femoral neck
         1. Line does not transect lateral 25% of femoral head in SCFE
   2. MRI Hip
      1. Consider in high suspicion cases where XRay is non-diagnostic
      2. May be indicated in early slippage
8. Management
   1. Orthopedic Emergency!
   2. Immediate hospitalization and operative fixation
   3. Spica hip Casting for 6 to 8 weeks
      1. Decreases risk of Femoral Neck Fracture
      2. Protects epiphyses
   4. Severe chronic Slipped Capital Femoral Epiphyses
      1. Requires osteotomies to realign and stabilize
9. Complications
   1. Avascular necrosis of the femoral head
   2. Premature closure of the femoral head growth plate