Slipped Capital Femoral Epiphysis
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Basics
Description
- Femoral epiphysis translates (slips) posteriorly and inferiorly relative to the femoral head/neck
- Classification systems:
- Degree of femoral head “slip” as a percentage of femoral neck diameter:
- (Mild, grade 1) <33.3%
- (Moderate, grade 2) 33.3–50%
- (Severe, grade 3) >50%
- Temporal:
- Acute: <3 wk of symptoms
- Chronic: >3 wk of symptoms
- Acute on chronic: >3 wk of symptoms, now with acute pain
- Stability:
- Stable: Bears weight w/or w/o crutches
- Unstable: Unable to bear weight
- Degree of femoral head “slip” as a percentage of femoral neck diameter:
- Epidemiology:
- Peak age: 12–14 yr (boys), 11–13 yr (girls)
- Male > female (1.5:1)
- Bilateral slips: 20% at presentation; additional 20–40% progress to bilateral
- Atypical SCFE: Endocrinopathy associated:
- Patient may be <10 yr age, >16 yr age, or weight <50th percentile
- High risk of bilateral SCFE (up to 100%)
Etiology
- Proximal physis position changes in adolescence from horizontal to oblique; hence hip forces shift from “compression” to “shear”
- Shear force > strength of femoral physis
- Weakest point of physis = zone of hypertrophy
- Risk factors:
- Obesity: May contribute to shear forces
- Down syndrome
- Endocrinopathy such as hypothyroidism, growth hormone deficiency, renal osteodystrophy (2° hyperparathyroidism): May contribute to growth plate weakening
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Femoral epiphysis translates (slips) posteriorly and inferiorly relative to the femoral head/neck
- Classification systems:
- Degree of femoral head “slip” as a percentage of femoral neck diameter:
- (Mild, grade 1) <33.3%
- (Moderate, grade 2) 33.3–50%
- (Severe, grade 3) >50%
- Temporal:
- Acute: <3 wk of symptoms
- Chronic: >3 wk of symptoms
- Acute on chronic: >3 wk of symptoms, now with acute pain
- Stability:
- Stable: Bears weight w/or w/o crutches
- Unstable: Unable to bear weight
- Degree of femoral head “slip” as a percentage of femoral neck diameter:
- Epidemiology:
- Peak age: 12–14 yr (boys), 11–13 yr (girls)
- Male > female (1.5:1)
- Bilateral slips: 20% at presentation; additional 20–40% progress to bilateral
- Atypical SCFE: Endocrinopathy associated:
- Patient may be <10 yr age, >16 yr age, or weight <50th percentile
- High risk of bilateral SCFE (up to 100%)
Etiology
- Proximal physis position changes in adolescence from horizontal to oblique; hence hip forces shift from “compression” to “shear”
- Shear force > strength of femoral physis
- Weakest point of physis = zone of hypertrophy
- Risk factors:
- Obesity: May contribute to shear forces
- Down syndrome
- Endocrinopathy such as hypothyroidism, growth hormone deficiency, renal osteodystrophy (2° hyperparathyroidism): May contribute to growth plate weakening
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