SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)

SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)


SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)

Known by various names as:

  • Slipped Upper Femoral Epiphysis (SUFE)
  • adolescent coxa vara
  • epiphyseal coxa vara
  • epiphyseolisthesis

 

  

  • Characterized by a displacement of the capital femoral epiphysis from the femoral neck through the physeal plate.
  • Occurs commonly during 12-18 years.
  • The slip may be acute, gradual or acute on a gradual.
Predisposing Factors
  • M:F ratio 5:1.
  • Left hip is commonly affected
  • Obesity
  • Weakening & thinning of the physis
  • Altered inclination of the upper femoral physis
  • Relative or absolute retroversion of femoral neck
Clinical Features

  1. Adolescent age with obese or tall built, should increase the suspicion.
  2. Pain in the hip of gradual onset (at times may present with knee pain).
  3. Progressive limp.
  4. Progressive limitation of movement.
  5. Progressive deformity of adduction and external rotation.
  6. Presence of ‘Axis deviation’ sign 
  7. (Flexion of the hip causes the abduction and external rotation of the limb and the limb falls away from the shoulder).
  8. Antalgic gait (indicates that the slip is unstable).

Investigations

  • X-rays of both hips are to be taken as the slip may be bilateral.
  • If unilateral, opposite hip is used for comparison.
1. AP View

Klein’s Line:

  • Suspect slippage (SCFE) if the line passes superiorly

 

Trethowan sign:

  • line of Klein passes above the femoral head.

 

2. Lateral View

  • More reliable
  • Identifies even the minor degrees of the slip.

3. Frog Leg View

  • A straight line drawn along the center of the femoral neck
  • When continued proximally, passes through the center of the epiphysis in frog leg view.
  • If it passes anteriorly, it indicates SCFE.

 

4. SCFE findings

  • Widening of the femoral head physis
  • Irregularity of the growth plate
  • Slippage of the epiphysis “ice cream falling off of the cone”

 

Radiological Classification of the Slip

  • Type I slip—less than 33% displacement.
  • Type II slip—between 33% and 50% displacement.
  • Type III slip—greater than 50% displacement.

 

Treatment

1. STABLE SCFE
  • The standard treatment of stable SCFE is in situ fixation with a single screw. 

 
2. UNSTABLE SCFE

  • Treatment of unstable SCFE progressively shifted exclusively towards surgical pinning.
  • Conservative management (e.g. limitation of activity and casting) is no longer recommended.
  • Treatment of the contralateral hip is more controversial.

Complications

  • long term degenerative osteoarthritis: ~90%
  • avascular necrosis of the femoral head (10-15%)
  • chondrolysis (7-10%): acute cartilage necrosis 
  • deformity
  • limb length discrepancy

Exam Important

 

 

 

 

  

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