61:
434:(risk of 25 percent). Almost all cases require surgery, which usually involves the placement of one or two pins into the femoral head to prevent further slippage. The recommended screw placement is in the center of the epiphysis and perpendicular to the physis. Chances of a slippage occurring in the other hip are 20 percent within 18 months of diagnosis of the first slippage and consequently the opposite unaffected femur may also require pinning.
319:
relationship of the proximal fragment (capital femoral epiphysis) to the normal distal fragment (femoral neck). Because the physis has yet to close, the blood supply to the epiphysis still should be derived from the femoral neck; however, this late in childhood, the supply is tenuous and frequently lost after the fracture occurs. Manipulation of the fracture (as in an attempted reduction, especially a forceful one) frequently results in
340:
37:
318:
The fracture occurs at the hypertrophic zone of the physeal cartilage. Stress on the hip causes the epiphysis to move posteriorly and medially, relative to the metaphysis. Although it is not the epiphysis that displaced, by convention, position and alignment in SCFE is described by referring to the
437:
The risk of reducing this fracture includes the disruption of the blood supply to the bone. It has been shown in the past that attempts to correct the slippage by moving the head back into its correct position can cause the bone to die. Therefore the head of the femur is usually pinned 'as is'. A
310:
or growth plate) through the proximal femoral physis, which can be distinguished from other Salter-Harris type 1 fractures by identifying prior epiphysiolysis, an intact (in chronic SCFE) or partially torn (in acute SCFE) periosteum, and the displacement being slower. Stress around the hip causes a
270:
In general, SCFE is caused by increased force applied across the epiphysis, or a decrease in the resistance within the physis to shearing. Obesity is the by far the most significant risk factor. A study in
Scotland looked at the weight of 600,000 infants, and followed them up to see who got SCFE.
450:
SCFEs are most common in adolescents 11–15 years of age, and affects boys more frequently than girls (male 2:1 female). It is strongly linked to obesity, and weight loss may decrease the risk. Other risk factors include: family history, endocrine disorders, radiation / chemotherapy, and mild
446:
SCFE affects approximately 1–10 per 100,000 children. The incidence varies by geographic location, season of the year, and ethnicity. In eastern Japan, the incidence is 0.2 per 100,000 and in the northeastern U.S. it is about 10 per 100,000. Africans and
Polynesians have higher rates of SCFE.
215:. The pain may occur on both sides of the body (bilaterally), as up to 40 percent of cases involve slippage on both sides. In cases of bilateral SCFEs, they typically occur within one year of each other. About 20 percent of all cases include a SCFE on both sides at the time of presentation.
335:
The diagnosis is a combination of clinical suspicion plus radiological investigation. 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. 20–50% of SCFE are missed or misdiagnosed on their first
314:
An intrinsic weakness in the physis with a high axial load is the hypothesized mechanism. Obesity is the most important predisposing factor in the development of SCFE (working by increasing axial load). The physis being more vertical and weak, perichondrial ring being thin and unlocking of
271:
This study identified that obese children had an almost twenty times greater risk than thin children, with a 'dose-response'- so the greater the weight of the child, the greater the risk of SCFE. In 65 percent of cases of SCFE, the person is over the 95th percentile for weight.
187:
SCFE is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. One in five cases involves both hips, resulting in pain on both sides of the body. SCFEs occurs slightly more commonly in
970:
Merz, Michael K.; Amirouche, Farid; Solitro, Giovanni F.; Silverstein, Jeffrey A.; Surma, Tyler; Gourineni, Prasad V. (2014). "Biomechanical
Comparison of Perpendicular Versus Oblique in Situ Screw Fixation of Slipped Capital Femoral Epiphysis".
430:. In severe cases, after enough rest the patient may require physical therapy to regain strength and movement back to the leg. A SCFE is an orthopaedic emergency, as further slippage may result in occlusion of the blood supply and
346:
The diagnosis requires x-rays of the pelvis, with anteriorposterior (AP) and frog-leg lateral views. The appearance of the head of the femur in relation to the shaft likens that of a "melting ice cream cone", visible with
199:. Whilst it can occur in any child, the major risk factor is childhood obesity. Symptoms include the gradual, progressive onset of thigh or knee pain with a painful limp. Hip motion will be limited, particularly
294:(hormone-related) factors. Skeletal changes may also make someone at risk of SCFE, including femoral or acetabular retroversion, those these may simply be chronic skeletal manifestations of childhood obesity.
336:
presentation to a medical facility. SCFEs may be initially overlooked, because the first symptom is knee pain, referred from the hip. The knee is investigated and found to be normal.
160:, called the capital, should sit squarely on the femoral neck. Abnormal movement along the growth plate results in the slip. The term slipped capital femoral epiphysis is actually a
203:. Running, and other strenuous activity on legs, will also cause the hips to abnormally move due to the condition and can potentially worsen the pain. Stretching is very limited.
419:
is necessary to repair this problem. Pinning the unaffected side prophylactically is not recommended for most patients, but may be appropriate if a second SCFE is very likely.
438:
small incision is made in the outer side of the upper thigh and metal pins are placed through the femoral neck and into the head of the femur. A dressing covers the wound.
836:
807:
311:
shear force to be applied at the growth plate, with metaphysis anteriorly translating and externally rotating, while epiphysis remains within acetabulum.
211:
Usually, a SCFE causes groin pain, but it may cause pain in only the thigh or knee, because the pain may be referred along the distribution of the
463:
1059:
577:
290:
Sometimes no single cause accounts for SCFE, and several factors play a role in the development of a SCFE i.e. both mechanical and
315:
interlocking mamillary processes - in adolescence - contributes to high incidence. The condition is also more common in boys.
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The left hip is more often affected than the right. Over half of cases may have involvement on both sides (bilateral).
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The disease can be treated with external in-situ pinning or open reduction and pinning. Consultation with an
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of the hip joint later in life. 17–47 percent of acute cases of SCFE lead to the death of bone tissue (
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60:
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54:
180:. It is actually the metaphysis (neck part of a bone) which slips in an anterior direction with
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466:– another cause of avascular necrosis of the femoral head, seen in younger children than SCFE
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X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.
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1000:
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254:), gait abnormalities and chronic pain. SCFE is associated with a greater risk of
222:, decreased range of motion. Often the range of motion in the hip is restricted in
644:"Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History"
373:
Unstable, practically defined as when the patient is unable to ambulate even with
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97:
90:
1086:
743:
Perry, Daniel C.; Metcalfe, David; Costa, Matthew L.; Van Staa, Tjeerd (2017).
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246:
Failure to treat a SCFE may lead to: death of bone tissue in the femoral head (
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may also contribute (though are far less of a risk than obesity), such as
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161:
498:
Perry, Daniel C.; Metcalfe, David; Lane, Steven; Turner, Steven (2018).
231:
196:
142:
102:
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526:
30:
Slipped upper femoral epiphysis, coxa vara adolescentium, SCFE, SUFE
234:. A person with a SCFE may prefer to hold their hip in flexion and
338:
192:
157:
36:
1097:
918:"Surgical management of healed slipped capital femoral epiphysis"
1064:
745:"A nationwide cohort study of slipped capital femoral epiphysis"
219:
75:
149:, which results in slippage of the overlying end of the femur (
880:"Slipped capital femoral epiphysis: diagnosis and management"
922:
The
Journal of the American Academy of Orthopaedic Surgeons
500:"Childhood Obesity and Slipped Capital Femoral Epiphysis"
351:. The severity of the disease can be measured using the
195:, especially young black males, although it also affects
642:
Novais, Eduardo N.; Millis, Michael B. (December 2012).
572:(19th ed.). Philadelphia: Saunders. p. 2363.
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327:) because of the tenuous nature of the blood supply.
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74:Groin pain, referred knee and thigh pain, waddling
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48:
26:
21:
422:Once SCFE is suspected, the patient should be non-
916:Kuzyk, Paul R.; Kim, YJ; Millis, MB (Nov 2011).
850:Pediatric Orthopaedic Society of North America.
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871:
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835:: CS1 maint: multiple names: authors list (
806:: CS1 maint: multiple names: authors list (
323:and the acute loss of articular cartilage (
168:(end part of a bone) remains in its normal
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854:. American Academy of Orthopaedic Surgeons
648:Clinical Orthopaedics and Related Research
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145:term referring to a fracture through the
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7:
1015:"Slipped Capital Femoral Epiphysis"
852:"Slipped Capital Femoral Epiphysis"
715:"Slipped capital femoral epiphysis"
595:"Slipped capital femoral epiphysis"
218:Signs of a SCFE include a waddling
477:– Clinical test examining for SCFE
14:
1019:U.S. National Library of Medicine
973:Journal of Pediatric Orthopaedics
823:Slipped Capital Femoral Epiphysis
794:Slipped Capital Femoral Epiphysis
719:U.S. National Library of Medicine
692:Slipped Capital Femoral Epiphysis
250:), degenerative hip disease (hip
115:Slipped capital femoral epiphysis
22:Slipped capital femoral epiphysis
934:10.5435/00124635-201111000-00003
821:Johns, Mabrouk, Tavarez (2022).
792:Johns, Mabrouk, Tavarez (2022).
761:10.1136/archdischild-2016-312328
749:Archives of Disease in Childhood
127:slipped upper femoral epiphysis
1021:. National Institute of Health
1:
570:Nelson textbook of pediatrics
304:Salter-Harris type 1 fracture
985:10.1097/BPO.0000000000000379
825:. StatPearls Publishing LLC.
796:. StatPearls Publishing LLC.
568:Kliegman, Robert M. (2011).
404:Grade III = >50% slippage
878:Peck, David (Aug 1, 2010).
464:Legg–Calvé–Perthes syndrome
1186:
401:Grade II = 34–50% slippage
156:Normally, the head of the
884:American Family Physician
660:10.1007/s11999-012-2452-y
599:American Family Physician
43:
34:
593:Loder, RT (1 May 1998).
398:Grade I = 0–33% slippage
178:ligamentum teres femoris
176:(hip socket) due to the
605:(9): 2135–42, 2148–50.
139:coxa vara adolescentium
517:10.1542/peds.2018-1067
343:
306:(fracture through the
426:and remain on strict
367:Loder classification
342:
147:growth plate (physis)
285:renal osteodystrophy
1170:Medical terminology
417:orthopaedic surgeon
170:anatomical position
1160:Skeletal disorders
1108:External resources
432:avascular necrosis
344:
273:Endocrine diseases
248:avascular necrosis
207:Signs and symptoms
55:Orthopedic surgery
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755:(12): 1132–1136.
713:Kaneshiro, Neil.
654:(12): 3432–3438.
236:external rotation
224:internal rotation
201:internal rotation
182:external rotation
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281:hypopituitarism
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80:range of motion
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98:Risk factors
1117:MedlinePlus
616:30 November
262:) effects.
91:Adolescence
87:Usual onset
27:Other names
1149:Categories
1082:DiseasesDB
1025:1 December
955:1 December
901:1 December
858:1 December
725:1 December
527:2164/13140
504:Pediatrics
482:References
302:SCFE is a
190:adolescent
174:acetabulum
151:metaphysis
1128:eMedicine
1093:SNOMED CT
831:cite book
802:cite book
697:eMedicine
411:Treatment
381:Temporal
331:Diagnosis
292:endocrine
256:arthritis
228:abduction
166:epiphysis
50:Specialty
1098:26460006
1001:11578375
993:25526584
950:38580394
942:22052643
896:20672790
779:28663349
678:23054509
536:30348751
458:See also
451:trauma.
428:bed rest
375:crutches
162:misnomer
70:Symptoms
1076:D060048
770:5754864
669:3492592
611:9606305
387:Chronic
232:flexion
197:females
172:in the
143:medical
141:) is a
103:Obesity
1122:000972
1065:182260
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370:Stable
308:physis
283:, and
230:, and
135:souffy
123:skiffy
82:of leg
57:
1087:12185
997:S2CID
946:S2CID
384:Acute
266:Cause
193:males
158:femur
1071:MeSH
1060:OMIM
1027:2012
989:PMID
957:2012
938:PMID
903:2012
892:PMID
860:2012
837:link
808:link
775:PMID
727:2012
674:PMID
618:2012
607:PMID
574:ISBN
532:PMID
220:gait
131:SUFE
119:SCFE
76:gait
981:doi
930:doi
765:PMC
757:doi
753:102
695:at
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656:doi
652:470
522:hdl
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