3 INCIDENCE AND EPIDEMIOLOGY The usual deformity consists of an upward and anterior movement of the femoral neck on the capital epiphysis.The incidence of SCFE varies according to race,sex, and geographic location: The incidence is estimated to be approximately 2 per 100,000 population,
4 INCIDENCE AND EPIDEMIOLOGY There is a definite predilection for males to beaffected more often than females(5/1), and for the left hip to be affected more often than the right(3/1).Slipped epiphysis typically occurs during adolescence (boys, 13 to 15 years of age, averaging about 14years; and girls, 11to 13years of age, averaging about 12 years) a period of maximal skeletal growth.
5 INCIDENCE AND EPIDEMIOLOGY When SCFE occurs in a juvenile (10 years of age and younger) or in a patient with an open physis older than 16 years of age, careful assessment for an underlying Endocrinopathy should be considered.Most studies identify bilateral involvementeither on initial presentation or subsequently inapproximately 20% to 25% of patients
6 CLASSIFICATIONAccording to onset of symptoms (acute, chronic, or acute-an-chronic)functionally, according to the patient's ability to bear weight (stable or unstable)or morphologically, as to the extent of displacement of the femoral epiphysis relative to the neck (mild, moderate, or severe),
7 CLASSIFICATIONAn acute SCFE has been characterized as one occurring in a patient with prodromal symptoms for 3 weeks or lessAcute slips present as a sudden, dramatic,fracture-like episode occurring after trauma too trivial to cause displacement of the epiphysis as a Salter- Harris type I fracture
8 CLASSIFICATIONChronic SCFE is the most frequent form of presentation. Typically, an adolescent presents with a few months history of vague groin pain, upper or lower thigh pain, and a limp.Radiographs of patients with chronic SCFE show a variable amount of posterior migration of the femoral epiphysis and remodeling of the femoral neck in the same direction
9 CLASSIFICATIONThe acute-on-chronic slipped epiphysis is one in which features of both ends of the spectrum are presentprodromal symptoms have been present for more than 3 weeks with a sudden exacerbation of pain, and radiographic evidence of both femoral neck remodeling and further displacement
10 Classification Functional Classification Patients who were unable to bear weight after the acute episode were identified as having unstable slips.those who were able to bear weight at the time of presentation to a physician were classified as having stable slips
11 Morphologic Classification Head-shaft anglemild slips less than 30 degrees from the normal contralateral sidemoderate slips theangle difference is between 30 and 60 degreessevere slips the angle differs by more than 60 degrees from the contralateral normal side.
12 ETIOLOGY Mechanical Factors THINNING OF THE PERICHONDRIAL RING COMPLEX RELATIVE OR ABSOLUTE FEMORAL RETROVERSIONCHANGE IN INCLINATION OF THE ADOLESCENT PROXIMAL FEMORAL PHYSIS RELATIVE TO THE FEMORAL NECK AND SHAFTASSOCIATED CONDITIONSBlount's disease , peroneal spastic flat foot and Legg-Calve-Perthes disease.
13 ETIOLOGY Endocrine Factors The stereotype of an obese, hypogonadal male (the so-called adiposogenital syndrome) presenting with chronic bilateral slipped epiphyses has long stimulated the thought that some alteration in the balance of thyroid, growth, and sex hormones was the cause of slipped epiphysis
14 CLINICAL FEATURES Stable, Chronic Slipped Capital Femoral Epiphysis pain in the region of the groin, which may bereferred to the anteromedial aspect of the thigh and knee.The loss of internal rotation on examination, with complaints of pain at the limit of internal rotation, is a key finding in stable SCFE.
16 Unstable Acute or Acute-on-Chronic Slipped Capital Femoral Epiphysis Clinical featuresUnstable Acute or Acute-on-Chronic Slipped Capital Femoral Epiphysissevere, fracture-like pain in the affected hip region, usually as the result of a relatively minor fall or twisting injury.the patient unable to bear weight and likely to seek prompt medical attention.
17 RADIOGRAPHIC FINDINGS Plain RadiographyAP and lateral views(Klein's line) on the AP view
18 TREATMENT STABLE SLIPPED CAPITAL FEMORAL EPIPHYSIS Percutaneous In Situ Fixation with a Fracture Table