1. Slipped capital femoral epiphysis( SCFE )
Coxa vara adolescentium
Fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (epiphysis)
Abnormal movement along the growth plate results in the slip
The femoral epiphysis remains in the acetabulum (hip socket), while the metaphysis (end of the femur) move in an anterior direction with external rotation.

2. Slipped capital femoral epiphysis
Hip disorder in adolescence
Groin pain on the affected side, cause knee or thigh pain
One in five cases involve both hips, resulting in pain on both sides of the body.
Obse adolescent males, especially young Black malesit

3. Signs and symptoms :
Groin pain referred along the distribution of the obturator nerve.
Pain may occur on both sides of the body (bilaterally)
Up to 40 percent of cases involve slippage on both sides.
Waddling gait, decreased range of motion
Hip is restricted in internal rotation, abduction, and flexion

4. Classification : Loder classification Atypical / Typical * Stable
* Unstable, practically defined as when the patient is
unable to ambulate even with crutches

5. Radiological : Grade I = 0-33% slippage Grade II = 34-50% slippage
Grade III = >50% slippage

6. Cause :
Increased force applied across the ephysis, or a decrease in the resistance within the physis to shearing.
Mechanical and endocrine (hormone-related) factors.
Mechanical risk factors include obesity, coxa profunda, femoral or acetabular retroversion.
Obesity is the most significant risk factor. In 65 percent of cases of SCFE, the person is over the 95th percentile for weight.
Common misconception is heredity.
Endocrine diseases (hypothyroidism, hypopituitarism, and renal osteodystrophy )

7. Pathophysiology :
Salter-Harris type 1 fracture through the proximal femoral physis.
Stress around the hip causes a shear force the growth plate.
Trauma has a role of the fracture, an intrinsic weakness in the physeal cartilage.
Adolescent growth spurt indicates a hormonal role.
Obesity is another key predisposing factor.

8. Pathophysiology :
The fracture occurs at the hypertrophic zone of the physeal cartilage
Stress on the hip causes the epiphysis to move posteriorly and medially
Manipulation of the fracture frequently results in osteonecrosis and the acute loss of articular cartilage (chondrolysis) because of the tenuous nature of the blood supply.

9. Diagnosis : Radiological investigation AP and frog-leg lateral views
(melting ice cream cone) visible with Klein's line
Southwick angle
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 presentation to a medical facility ( knee pain)

10. Treatment : In-situ pinning or open reduction and pinning.
Pinning the unaffected side is not recommended.
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 avascular necrosis

11. Treatment :
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
The risk of reducing this fracture includes the disruption of the blood supply to the bone that attempts to correct the slippage by moving the head back into its correct position can cause the bone to die.

12. Complications :
Death of bone tissue in the femoral head (avascular necrosis)
Degenerative hip disease (hip osteoarthritis)
Gait abnormalities and chronic pain
17-47 percent of acute cases of SCFE lead to the death of bone tissue (osteonecrosis) effects.

13. Summary : Most common in adolescents 11–15 years of age
Affects boys more frequently than girls (male 2:1 female )
Strongly linked to obesity, and weight loss may decrease the risk
Family history, endocrine disorders, radiation / chemotherapy, and mild trauma.
The left hip is more often affected than the right
Over half of cases may have involvement on both sides (bilateral )

14. Further References :
Peck, D. (2010). "Slipped capital femoral epiphysis: Diagnosis and management". American family physician.
82 (3): 258–262.

15. Q & A
Dr. 熊永萬
Dr. Bear