II. Epidemiology

  1. Occurs during maximal pubertal growth spurt
    1. Males: age 14 to 16 years
    2. Females: age 11 to 13 years
  2. Most common adolescent hip disorder
    1. Incidence: 1 to 4 per 100,000
  3. Black and hispanic children affected more often than white children
  4. Unilateral involvement in 90% of cases
  5. Child is often Overweight or obese

III. Risk Factors: Younger onset or atypical cases

IV. Pathophysiology

  1. Occurs before the Epiphyseal Plate closes

V. Symptoms

  1. Hip Pain with indolent course
    1. Unilateral in 90% of cases
  2. Pain may be referrred to knee
    1. May present primarily as knee or thigh pain in 25% of cases

VI. Signs

  1. Hip held in abduction and external rotation
  2. Markedly limited internal rotation

VII. Imaging

  1. Hip XRay with Frog-Leg View (Compare sides)
    1. Widened Epiphyseal Plate
    2. Displacement of femoral head
    3. Draw line down the femoral neck (Klein's Line)
      1. Line does not transect lateral 25% of femoral head in SCFE
      2. Frog-leg view is important, as AP Hip will miss diagnosis in up to 60% of cases
  2. MRI Hip
    1. Consider in high suspicion cases where XRay is non-diagnostic
    2. May be indicated in early slippage

VIII. Management

  1. Orthopedic Emergency!
  2. Non-weight bearing status
  3. Immediate hospitalization and operative fixation
  4. Spica hip Casting for 6 to 8 weeks
    1. Decreases risk of Femoral Neck Fracture
    2. Protects epiphyses
  5. Severe chronic Slipped Capital Femoral Epiphyses
    1. Requires osteotomies to realign and stabilize

IX. Complications

  1. Avascular Necrosis of the Femoral Head
  2. Premature closure of the femoral head Growth Plate

X. References

  1. Jhun and Raam in Herbert (2016) EM:Rap 16(2):15-6

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Ontology: Slipped Capital Femoral Epiphyses (C0149887)

Definition (MSH) A developmental deformity in which the metaphysis of the FEMUR moves proximally and anteriorly away from FEMUR HEAD (epiphysis) at the upper GROWTH PLATE. It is most common in male adolescents and is associated with a greater risk of early OSTEOARTHRITIS of the hip.
Concepts Disease or Syndrome (T047)
MSH D060048
Dutch epifysiolyse heupkop
French Epiphysiolyse fémorale supérieure, Coxa vara de l'adolescent, Épiphysiolyse de la tête fémorale, Glissement de l'épiphyse fémorale supérieure, Glissement épiphysaire fémoral supérieur, Épiphysiolyse fémorale supérieure, Épiphysiolyse de l'adolescent
German verrutschte Femurkopfepiphyse, Adoleszente Coxa Vara, Jugendliche Hüftkopflösung, Jugendliche Hueftkopfloesung, Epiphyseolysis capitis femoris, Coxa Vara beim Adoleszenten
Italian Frattura cronica dell'epifisi della testa del femore, Slittamento dell'epifisi femorale
Portuguese Epifisiólise da cabeça do fémur, Escorregamento das Epífises Proximais do Fêmur, Escorregamento Epifisário Proximal do Fêmur, Escorregamento da Epífise Proximal do Fêmur
Spanish Epífisis femoral superior dislocada, Epífisis Desprendida de Cabeza Femoral
Japanese 大腿骨頭すべり症, ダイタイコットウスベリショウ, ダイタイコツトウスベリショウ
English Slipped capital femoral epiphyses, EPIPHYSIOLYSIS CAPITIS FEMORIS, SLIPPED FEMORAL CAPITAL EPIPHYSES, Proximal femoral epiphysiolysis, slipped femoral capital epiphysis, capital epiphysis femoral slipped, Adolescent Coxa Vara, Slipped Capital Femoral Epiphyses, Coxa Varas, Adolescent, Coxa Vara, Adolescent, Adolescent Coxa Varas, Slipped Capital Femoral Epiphysis, Slipped Capital Femoral Epiphyses [Disease/Finding], Slipped Femoral Capital Epiphyses, Epiphysiolysis Capitis Femoris, Slipped femoral capital epiphysis
Czech Sklouzlá horní femorální epifýza, epifyseolysis capitis femoris, sklouznutí hlavice stehenní kosti, coxa vara dospívajících, kyčelní kloub - posun epifýzy hlavice, skluz hlavice kosti stehenní dospívajících, coxa vara adolescentium, CVA, sklouznutí epifýzy femuru
Hungarian Félrecsúszott comb epiphysisfej
Russian PODROSTKOV SHEIKI BEDRA VARUSNAIA DEFORMATSIIA, PODROSTKOVAIA KOKSA VARA, СМЕЩЕНИЕ ЭПИФИЗА ГОЛОВКИ БЕДРЕННОЙ КОСТИ, ПОДРОСТКОВ ШЕЙКИ БЕДРА ВАРУСНАЯ ДЕФОРМАЦИЯ, ЭПИФИЗИОЛИЗ ГОЛОВКИ БЕДРЕННОЙ КОСТИ, ПОДРОСТКОВАЯ КОКСА ВАРА, SMESHCHENIE EPIFIZA GOLOVKI BEDRENNOI KOSTI, EPIFIZIOLIZ GOLOVKI BEDRENNOI KOSTI
Polish Złuszczenie głowy kości udowej młodzieńcze, Młodzieńcze złuszczenie głowy kości udowej