slipped capital femoral epiphysis

SCFE

  • pt: overweight adolescents, AA, hypothyroidism, down syndrome, or thin pt with rapid growth spurt
  • cause:
    • slippage of epiphysis relative to metaphysis at growth plate
    • Cartilage in the hypertrophic zone acts as the weak point where the slippage occurs.
  • symptoms:
    • presents with a limp. Pain when moving hips
    • thigh and groin pain, knee pain
    • Trendelenburg gait
    • external rotation in passive hip flexion (limited hip flexion)
    • limited hip internal rotation and abduction
  • dx:
    • xray: AP and frog leg showing the epiphysis remaining within the acetabulum while the neck displaces anteriorly and externally rotates leaving the head posterior to the neck. An early radiographic finding is epiphysiolysis where the growth plate is widened or shows increased lucency

Treatment

Treatment options are primarily surgical with percutaneous pinning of the slipped side. Treatment of this condition is emergent.

Prophylactic pinning of the non-slipped side should be considered in cases of slipped capital femoral epiphysis related to hypothyroidism.

Complications of slipped capital femoral epiphysis include avascular necrosis, chondrolysis, and premature osteoarthritis.

frog leg xray:

DzAgeSymptomsDiagnosisTreatment
DDHNewbornclicky hipUS at 4 wksHarness to line up joints
LCP6 yoSlow onset, antalgic gaitXrayCast
SCFE13 yogrowth spurt, fat. Nontraumatic joint pain.Frog-leg xraySurgery
SJAnyfever, leukocytosis, ESR, CRP, can't bear weight. Pain with movement of leg. Osteomyelits has focal pain.Arthrocentesis > 50k WBCIND, Abx
TSAnyHip pain, weeks after viral, can't bear weight.ClxSupportive