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Slipped Capital Femoral Epiphysis
Overview
In slipped capital femoral epiphysis (SCFE), the femoral head (the proximal ("capital") epiphysis of the femur) slips backwards and inwards off the femoral neck. It most commonly occurs in obese adolescents during a growth spurt.
Epidemiology
SCFE is a relatively common cause of hip pain (~ 1 in 5,000) and typically occurs in obese in adolescents (~ 10 to 16 yo). It is more common in males (2:1 male to female ratio).
It is either bilateral at onset or unilateral with progression to bilateral in at least half of cases.
Risk factors
Key risk factors for SCFE are as follows:
- Severe obesity is the biggest risk factor.
- Growth spurt is the most common timeframe for presentation.
- Genetic predispositions include Down syndrome and Rubenstein-Taybi syndrome
Pathogenesis
In SCFE, the femoral head (the proximal ("capital") epiphysis of the femur) slips off the femoral neck in the following direction: inferiorly, medially, and posteriorly. It slides through the growth plate (aka, the physeal plate or physis) BUT remains within the acetabulum (the hip socket).
At the same time, the metaphysis (which lies beneath the femoral neck) displaces in the opposite direction, away from the hip: superiorly, laterally, and anteriorly.
The X-Ray imaging mimics that of ice cream slipping out of a cone.
Presentation
SCFE classically presents in an obese adolescent undergoing a growth spurt who complains of dull, aching pain in the hip (or groin, thigh, or knee) with inability to bear weight on the leg causing an altered gait.
Diagnosis
X-Ray imaging with anterior-posterior and lateral views (frog-leg or cross-table). Note that the lateral view is more reliable for identifying the posterior displacement of the epiphysis on the femoral neck.
Other imaging modalities and ancillary testing can be used.
Note that imaging can miss early presentations before there is substantial slippage.
Management
Surgical stabilization is the key management for SCFE.
Complications
Complications include:
- Osteonecrosis of the femoral head
- Growth plate fracture and unequal femur growth
- Chondrolysis, which refers to joint space narrowing and thinning of joint cartilage
- Femoroacetabular impingement
- Osteoarthritis is a longer-term potential complication
Comparison
Compare slipped capital femoral epiphysis to Legg-Calvé-Perthes disease.