The potential for complications and unsatisfactory outcomes is high, especially due to avascular necrosis. Slipped capital femoral epiphysis boston childrens hospital. Slipped capital femoral epiphysis scfe is a hip disorder that occurs in school. It is separated from the main part of the bone by the growth plate. Treatment and care treatment will begin immediately to try to prevent the slipped capital femoral epiphysis from getting worse. The goals of treatment are to prevent slip progression and avoid complications such as avascular necrosis. Frogleg lateral radiography of mild stable slipped capital femoral epiphysis. Slipped capital femoral epiphysis scfe for parents. Risk factors for readmission after surgical treatment of. Slipped capital femoral epiphysis scfe is a common hip disorder in children and adolescents, and it consists in posteroinferior migration of the epiphysis in metaphysis through the physis in proximal femur. Slipped capital femoral epiphysis scfe is an condition of the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis, and is most commonly seen in adolescent obese males. Slipped capital femoral epiphysis genetic and rare. The epiphysis is the end of a long bone and is joined to the bone at the growth plate physis.
Slipped upper femoral epiphysis sufe, also known as a slipped capital femoral epiphysis scfe, is a relatively common condition affecting the physis of the. The etiology and treatment of slipped capital femoral epiphysis remain controversial. Slipped capital femoral epiphysis scfe is a shift at the upper part of the thighbone, or femur, that results in a weakened hip joint. Whether gh therapy plays a role in this disorder has been difficult to determine, in part because the incidence of slipped capital femoral epiphysis varies with age, gender, race, and geographic locale. Treatment usually requires an operation where a screw is inserted to stabilise the growth plate and prevent further slipping of the. The advent of fixation by a single cannulated screw has made this the operation of choice. A patient s guide to slipped capital femoral epiphysis. Slipped capital femoral epiphysis treatment algorithm. A slipped capital femoral epiphysis is also classified radiographically based on the degree of slip or displacement seen on xrays. For reasons that are not well understood, the ball at the upper end of the femur thigh.
Theories, including endocrine imbalances, rapid growth phases, or obesity, have been proposed as the etiology of this condition211. Diagnosis and treatment of slipped capital femoral epiphysis. A steel signon anteroposterior radiography, a double. Fortunately, when caught early, most cases of scfe can be treated successfully. Slipped capital femoral epiphysis scfe is a condition of the hip joint that affects children. Slipped capital femoral epiphysis scfe is a common hip disorder in.
Slipped capital femoral epiphysis scfe is an unusual disorder of the adolescent hip. Slipped capital femoral epiphysisscfe is a condition in which femoral head epiphysis or the head of the thigh bone slips off the neck of the thigh bone due to weak epiphysis present in the upper edge of the thigh bone. Slipped capital femoral epiphysis in children health. It is important to understand symptoms and imaging features to avoid delayed diagnosis. Slipped capital femoral epiphysis occurs in about 2 out of every 100,000 children. Slipped capital femoral epiphysis is a condition in which the epiphysis on the femoral head is displaced posteriorly with respect to the femoral neck, altering the mechanics and articular. Slipped capital femoral epiphysis is a condition in which the epiphysis on the femoral head is displaced posteriorly with respect to the femoral neck, altering the mechanics and articular structure of the joint and eventually causing inability to put any weight on the affected hip without pain. Slipped capital femoral epiphysis is associated with both hypothyroidism and ghd. As the concept of slip stability was introduced in 1993, studies before this date were not included.
Each entry has a summary of related medical articles. Slipped capital femoral epiphysis is a disorder in which the femoral head ball of the thigh bone slips off the neck of the femur thigh bone though the growth plate. This may occur suddenly acute or over a long period of time chronic. Slipped capital femoral epiphysisscfecausessymptoms. Slipped capital femoral epiphysis slipped capital femoral epiphysis surgery imaging in slipped capital femoral epiphysis. It is important to prevent the femoral head top of the thigh bone from further slippage. Slipped capital femoral epiphysis scfe is the most common hip disorder in the adolescent age group. Slipped capital femoral epiphysis scfe is a hip condition that occurs in teens and preteens who are still growing. Slipped capital femoral epiphysis scfe slipped capital femoral epiphysis scfe is an unusual but not rare disorder of the adolescent hip. In this condition, the growth center of the hip the capital femoral epiph. Anteroposterior radiography of leftsided slipped capital femoral epiphysis. The treatment of slipped capital femoral epiphysis is still not uniform among all orthopaedic surgeons. A physical exam, xrays, ct or mri scans will help doctors diagnose slipped capital femoral epiphysis.
After the diagnosis is made correct classification of the disease is required. Complications after cuneiform osteotomy for moderately or severely slipped capital femoral epiphysis. Treatment of stable slipped capital femoral epiphysis. Treatment of unstable slipped capital femoral epiphysis usually involves in situ fixation, but there is controversy about the timing of surgery, value of reduction, and whether traction should be used. It is meant for health care professionals and researchers. This study sought to evaluate postoperative complications and factors associated. Slipped capital femoral epiphysis is when the top part of the thighbone, shaped like a ball, slips off the straight part of the thighbone. The treatment of slipped capital femoral epiphysis with the modified dunn procedure allows the restoration of more normal proximal femoral anatomy by complete correction of the slip angle, such.
Treatment of slipped capital femoral epiphysis with a spica cast. Pdf the management of slipped capital femoral epiphysis. A slipped capital femoral epiphysis occurs when the upper, or capital, epiphysis of the thigh bone femur slips sideways off the end of the femur. Slipped capital femoral epiphysis symptoms, diagnosis. Treatment of slipped capital femoral epiphysis with a. The treatment for most patients with slipped capital femoral epiphysis scfe is well established but controversy remains as to how to manage the more difficult cases.
Femoral pseudoaneurysm as a complication of slipped capital. Slipped capital femoral epiphysis scfe is a common condition faced by an orthopaedic surgeon. The litany of complications associated with this condition is long. In 1962, watsonjones lamented that the treatment of displacement of upper femoral epiphysis is not a very happy chapter in the history of orthopaedic surgery. This part of the bone is where the leg grows new bone and is known as a growth plate. Diagnosis and treatment of slipped capital femoral. Slipped capital femoral epiphysis scfe is an orthopedic condition of children and adolescents. For reasons that are not well understood, the ball at the head of the femur thighbone slips off the neck of the bone in a backwards direction. Hefny division of paediatric orthopaedics and limb reconstruction surgery, department of orthopaedic surgery, faculty of medicine. This paper discusses the epidemiology, diagnosis, and treatment of scfe. Your child will be admitted into the hospital and put in bed. Slipped capital femoral epiphysis or scfe is a type of progressive disorder of the hip joint, which is more common among preteens and teens. Slipped capital femoral epiphysis scfe is one of the most important pediatric and adolescent hip disorders encountered in medical practice. Research suggests that 30% to 60% of children diagnosed with scfe will have it occur later in the other leg.
In scfe, the physis in the head of the femur thigh bone. Complications of treatment for proximal epiphysiolysis of the femoral head are frequent. Slipped capital femoral epiphysis scfe or slipped upper femoral epiphysis, sufe describes a type of break or fracture through the ball part of the ball and socket which forms the hip joint. Introduction slipped capital femoral epiphysis scfe is a condition that affects the hip in teenagers between the ages of 12 and 16 most often. Pdf the treatment for most patients with slipped capital femoral epiphysis scfe is well established but controversy remains as to how to. Scfe is often described as being like a scoop of ice cream slipping off the top of a cone. Controversies in management of slipped capital femoral. Slipped capital femoral epiphysis scfe or skiffy, slipped upper femoral epiphysis, sufe or souffy, coxa vara adolescentium is a medical term referring to a fracture through the growth plate physis, which results in slippage of the overlying end of the femur normally, the head of the femur, called the capital, should sit squarely on the femoral neck. Slipped capital femoral epiphysis scfe is not frequently encountered during routine practice and diagnosis and treatment are often delayed. Cases have been reported as early as age nine years old. Stable slipped capital femoral epiphysis is usually treated using in situ screw fixation. Slipped capital femoral epiphysis in black children. For reasons that are not well understood, the ball at the upper end of the femur thigh bone slips off in. Surgical hip dislocation in treatment of slipped capital.
Although it is a well recognised condition, commonly featured in major journals. Scfe usually occurs in those eight to 15 years of age and is one of. Although scfe is a rare condition, an accurate diagnosis combined with immediate treatment is critical. Slipped capital femoral epiphysis is a very frequently seen condition in. Acute slipped capital femoral epiphysis represents a unique type of proximal femoral epiphyseal instability. The treatment is to stabilize the bone so the ball doesnt slip anymore. Scfe usually occurs in those eight to 15 years of age and is one of the most commonly missed diagnoses in children. Slipped capital femoral epiphysis adolescent medicine.
Treatment options for slipped capital femoral epiphysis scfe range from in situ single screw fixation to more complex surgeries, such as. It most commonly affects older and teenage boys adolescents who are overweight. Slipped capital femoral epiphysis scfe is the most common hip disorder in adolescents, occurring in 10. Online mendelian inheritance in man omim is a catalog of human genes and genetic disorders. Treatment of unstable scfe is difficult and complication rate is high. In scfe, the ball of the thighbone femoral head slips off the neck of the thighbone. Slipped capital femoral epiphysis scfe is not an exception. In this condition, the problem occurs in the upper area while the bone is still growing.
Slipped capital femoral epiphysis treatment and surgery. Clinical examination will show a decrease in hip joint range of motion. Because of various factors, phy sicians often miss its diagnosis when patients initially present with vague symptoms. Treatment of the slipped capital femoral epiphysis remains a cause of concern due to the fact that the true knowledge of the etiopathogeny is unknown, as well as one of its major complications.
Orthopedics slipped capital femoral epiphysis scfe is a common, surgically treated adolescent hip condition. Often atraumatic or associated with a minor injury, slipped capital femoral epiphysis scfe is one of the most common adolescent hip disorders and represents a unique type of instability of the proximal femoral growth plate. A patients guide to slipped capital femoral epiphysis compliments of. Surgical hip dislocation in treatment of slipped capital femoral epiphysis mohammed elmarghany1,2,3, tarek m. A slipped capital femoral epiphysis may affect both hips. If scfe is caught early, there is a good chance for full recovery, especially if scfe is stable. Slipped capital femoral epiphysis in three generations. Scfe occurs in about one per 1,000 to one per 10,000 children and teens. Cuneiform osteotomy through the femoral neck achieves better correction but is technically demanding and associated with increased risk of osteonecrosis. Slipped capital femoral epiphysis surgery treatment. It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis. Treatment of slipped capital femoral epiphysiswhat is new. Pediatric orthopedics, wb saunders, philadelphia 1990.
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