Slipped Capital Femoral Epiphysis
Basics
Description
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
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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Citation
Schaider, Jeffrey J., et al., editors. "Slipped Capital Femoral Epiphysis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis.
Slipped Capital Femoral Epiphysis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis. Accessed December 3, 2024.
Slipped Capital Femoral Epiphysis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis
Slipped Capital Femoral Epiphysis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307398/all/Slipped_Capital_Femoral_Epiphysis.
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