SLIPPED CAPITAL FEMORAL
EPIPHYSIS
DEPARTMENT OF ORTHOPAEDICS
AFMC, PUNE
• INTRODUCTION
• INCIDENCE AND EPIDEMIOLOGY
• CLASSIFICATION
• ETIOLOGY
• PATHOLOGY
• CLINICAL FEATURES
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
INTRODUCTION
• During rapid growth in adolescence, weakening of
the upper femoral epiphysis
• Shearing stress from excessive body weight
• Displaces the femoral capital epiphysis from its
normal position relative to the femoral neck
• Deformity-Femoral neck and shaft-upward and
anterior
- Epiphysis-posterior displacement
Unilateral or bilateral involvement, second hip may
develop simultaneously or subsequently
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Incidence and Epidemiology
• 2:100,000 population
• Male: Female=2:1(Reduction in
male prevalence)
• Left >Right
• Incidence is twofold more in
black than whites
• Age : In boys 12-15 years
In girls 11-13 years
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
• Bilateral involement-20%-40%(50% of these
have bilateral involvement at initial
presentation
• Second slip usually occurs within 12-18months
of the initial slip
• Younger patients with endocrine or metabolic
abnormality are at much higher risk for
bilateral involvement
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Classification
• Functional classification
• Based on onset of symptoms
• Morphologic classification
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Functional classification
• Stable slip
• Unstable slip
• Stable –able to bear weight, full
or partial, with or without
crutches.
• Unstable-unable to bear weight
on the extremity-incidence of
AVN is high as 47%
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Classification based on onset of symptoms
• An acute SCFE
• Chronic SCFE
• An Acute on Chronic SCFE
Acute-less than 03 weeks
• Fracture like episode
• Severe pain
• Radiographic has little or no femoral neck remodeling
changes
• AVN rate 17%-47% in Acute SCFE
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Chronic SCFE
• >3weeks prior history of Acute SCFE
• Most common form of presentation
• Vague groin/upper thigh pain
• Limp
• Radiograph shows posterior migration of
femoral epiphysis-bending of the neck”
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Acute on Chronic
• Sudden exacerbation of pain
• With radiographic evidence of both femoral
neck remodeling with epiphysis displaced
beyond the remodeling point of femoral neck
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Morphologic classification
• Based on degree of displacement of femoral
epiphysis on the femoral neck
• Mild
• Moderate
• Severe
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Etiology
• Most patients cause is unknown
• Factors which play role are:
• Mechanical
• Endocrine
• Genetic
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Mechanical factor
Three important features:
• Thinning of the perichondral ring complex
• Relative or absolute femoral retroversion
• Change in the inclination of the adolescent
proximal femoral physis relative to the femoral
neck and shaft
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Endocrine factors
• Endocrine abnormality- hypogonadism,
hypothyroidism, growth hormone deficiency,
and chronic renal failure( due to secondary
hyperparathyroidism) association with SCFE
• 61% of patients with these disorders had
developed bilateral slips-thus prophylactic
pinning of the normal contralateral side must
be considered
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Pathology
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Clinical features
In stable, chronic SCFE
Pain-Groin region
Dull and vague
Intermittent or continuous
Exaggerated by physical activity
Referred to anteromedial aspect of thigh and
knee
Antalgic gait/Trendelenburg gait with limp
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Axis deviation: Hip is flexed with thigh
externally rotated
Local tenderness over anterior joint line
Restriction of internal rotation, abduction and
flexion
1-2cm shortening of affected limb
Loss of internal rotation with complain of pain
at the limit of internal rotation is key finding
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Unstable Acute Or Acute on chronic SCFE
Sudden onset of severe fracture like pain
Unable to bear weight
Affected limb in external rotation with moderate
shortening
Severe pain when any attempt of movements of the
limb
Chondrolysis (complicating SCFE)-Flexion contracture
of hip with global restriction of hip motion
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
Thank you
DEPARTMENT OF ORTHOPAEDICS, AFMC ,
PUNE
