Slipped capital femoral epiphysis

• Slipped capital femoral epiphysis = Juvenile slipped upper femoral epiphysis
• Epidemiology
  • Most common hip disorder in adolescents
  • Males > females
  • 6 – 16 years
• Etiology
  • Unknown cause
  • GH and sex hormone imbalance may be involved
  • Obesity and family history are risk factors
• Pathology
  • The femoral head (epiphysis) slips off the neck (metaphysis) in the line of the growth plate
  • Can be acute or chronic
• Clinical features
  • Often bilateral
  • Acute type
    • Sudden onset pain
  • Chronic type
    • Nagging groin/thigh/knee pain
    • Antalgic gait
  • Flexion, abduction, and internal rotation contracture
  • Features of sex hormone imbalance
    • Fat
    • No pubic hair
    • Delayed sexual development
• Diagnosis
  • X-ray
  • MRI
• Treatment
  • Always surgical – there is no conservative treatment
  • Urgent surgical internal fixation with screwing of the femoral head
    • Percutaneous procedure
    • Screw can be removed when child is done growing