Transcript Slipped capital femoral epiphysis (SCFE)

Slipped capital femoral
epiphysis (SCFE)
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
Incidence
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3/100,000 in whites
7/100,000 in blacks
Age:
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–
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Males 12-16 years
Females 10-14 years
M-F 2,4-1
L>R, bilateral in 25%
Etiology
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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
Predispositions
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Obesity
Rapid growth
Endocrinopathies
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–
–
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Hypothyroidism
Renal osteodystrophy
Pituitary deficiency
GH deficiency when treated with GH as this
causes rapid growth
Symptoms
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Limp
Pain
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–
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Groin
Femur
Knee
Lateral rotation aggravated when hip is
flexed
Decreased internal rotation
Classification
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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
Classification
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0 – pre slip
I – <30º (mild slip)
II – 30º – 60º (moderate slip)
a – 30º - 40º
b – 40º - 50º
c – 50º - 60º
III - >60º (severe slip)
Head-neck angle
Southwick- head-shaft angle
Classification - Loder
Stable
Unstable
Weight bearing Possible
Impossible
Severity of slip
More severe
Less severe
Good prognosis 96%
47%
Avn
50%
0%
Klein’s Line
Radiographs
Treatment
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Stabilisation of epiphysis and prevention
of further slippage
Stimulation of physeal plate arrest
Functional improvement by restoration
anatomy in severe cases
Treatment
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0 and I – in situ stabilization
•
II - in situ stabilization or inter- ,
subtrochanteric femoral osteotomy
•
III – subcapital femoral neck osteotomy,
inter- , subtrochanteric femoral
osteotomy
Stabilisation
Stabilisation
Stabilisation
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.
IRRITABLE HIP
(observation hip, toxic synovitis,
transitory coxitis, coxitis serosa, coxalgia
fugax, phantom hip, transient synovitis)
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
Etiology
• Bacterial/viral infection
• Trauma
• Allergic reaction
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%
Symptoms
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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
Diagnosis
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Clinical examination
USG- may show effusion
Rtg- usually normal
Laboratory- may be mild elevation of WBC,
ESR (OB)>20
Differential diagnosis
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Perthes disease
Septic arthritis
Osteomyelitis
Juvenile rhemoatoid arthritis
Slipped femoral epiphysis
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