slipped capital femoral epiphysis (scfe). scfe posterior and medial displacement of the femoral...
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Slipped capital femoral epiphysis (SCFE)
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SCFE
• Posterior and Medial displacement of the femoral capital epiphysis on the femoral neck through sudden or gradual deformation of the sub-capital growth plate
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Incidence
• 3/100,000 in whites
• 7/100,000 in blacks
• Age:– Males 12-16 years– Females 10-14 years
• M-F 2,4-1
• L>R, bilateral in 25%
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Etiology
• Mechanical – overload due to obesity, decreased anteversion, changes within physeal plate
• Inflammatory – synovial inflammation?• Hormonal – obesity, hypogonadal features in
boys, secondary and primary hypothyroidism, panhypopituarism, hypogonadal conditions, renal osteodystrophy, growth hormone therapy
• Trauma
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Predispositions
• Obesity• Rapid growth• Endocrinopathies
– Hypothyroidism– Renal osteodystrophy– Pituitary deficiency– GH deficiency when treated with GH as this
causes rapid growth
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Symptoms
• Limp
• Pain– Groin– Femur– Knee
• Lateral rotation aggravated when hip is flexed
• Decreased internal rotation
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Classification
• Acute slip – sudden, severe, fracture-like pain in the upper thigh after trauma
• Chronic slip – a few months history of vague pain in the groin, upper thigh and limp
• Acute on chronic slip – prodromal symptoms with exacerbation of pain
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Classification
• 0 – pre slip• I – <30º (mild slip)• II – 30º – 60º (moderate slip)
a – 30º - 40ºb – 40º - 50ºc – 50º - 60º
• III - >60º (severe slip)
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Head-neck angle
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Southwick- head-shaft angle
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Classification - Loder
50%0%Avn
47%96%Good prognosis
More severeLess severeSeverity of slip
ImpossiblePossibleWeight bearing
Unstable Stable
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Klein’s Line
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Radiographs
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Treatment
• Stabilisation of epiphysis and prevention of further slippage
• Stimulation of physeal plate arrest
• Functional improvement by restoration anatomy in severe cases
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Treatment
• 0 and I – in situ stabilization
• II - in situ stabilization or inter- , subtrochanteric femoral osteotomy
• III – subcapital femoral neck osteotomy, inter- , subtrochanteric femoral osteotomy
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Stabilisation
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Stabilisation
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Stabilisation
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Prognosis
• The majority of patients will be able to return to most sports and activities at approximately 3-6 months post-operatively.
• Removing the hardware is not necessary unless the patient develops pain or there is a problem with the screw itself.
• Because of the high association of bilaterality seen in SCFE (approx 25-40%), patients will need to be closely monitored to ensure that the contralateral hip does not slip.
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IRRITABLE HIPIRRITABLE HIP(observation hip, toxic synovitis,
transitory coxitis, coxitis serosa, coxalgia fugax, phantom hip, transient synovitis)
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Epidemiology
• Most common cause of hip pain• Reported incidence is 1 in 1000• From 9 months to adolescence (usually
between age 3 and 8 yrs -peak age is 6 yrs)
• More common in boys (2:1)• Whites• Never bilateral
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Etiology
• Bacterial/viral infection• Trauma• Allergic reaction
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Natural history
• Limited duration of symptoms (average 10 days- may be as long as 8 weeks)
• Recurrence uncommon (< 10%)• May be mild radiographic changes in hip• Coxa magna and femoral neck widening• Association with perthes disease in 1.5%
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Symptoms
• Acute hip pain (thigh, groin or knee) • Limp with or without pain• Stance phase shorter for affected limb• Slightly raised temperature • Hip held in flexion, external rotation and
abduction• Protective muscle spasm• One side affected
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Diagnosis
• Clinical examination• USG- may show effusion• Rtg- usually normal• Laboratory- may be mild elevation of WBC,
ESR (OB)>20
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Differential diagnosis
• Perthes disease• Septic arthritis• Osteomyelitis• Juvenile rhemoatoid arthritis• Slipped femoral epiphysis
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Treatment
• Bed rest and analgesia until full ROM achieved
• Non-weight-bearing• Traction only for severe cases • NSAIDs- Naproxen 10mg/kg/d• Partial weight bearing on crutches until limp
resolves