slipped capital femoral epiphysis - كلية الطب · 2019-03-26 · slipped capital femoral...
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Slipped capital femoral
epiphysis
Done by : Marah Al-Hiary
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***objective :
1- Definition
2-Epidemiology
3-Presentation
4-Clinical features
5-Diagnosis
6-Complications
7-Treatment
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Anatomy of the femur :
*normally a growing femur has 4 main parts :
1-epiphysis
2-metaphysis
2- diaphysis
4- growth plate also called physis
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The cartilaginous growth plate has
cells that divide and enable the
bone to grow in length , these cells
are very active in adolescents and they
enable a growth.
During this period a growth plate is very
weak and vulnerable to shearing force
Before the growth plate is ossifies it supported by perichondrial ring which is CT that extends from
metaphysis to the epiphysis , it helps resist the shearing forces so the femoral head and neck don’t slip
away from each other
Eventually the cartilaginous growth plate ossifies and fuse with epiphysis
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Definition :
Slipped capital femoral epiphysis
SCEF is a medical term referring to a fracture through the
growth plate (physis), which results in slippage of the
overlying end of the femur from the femoral neck caused by
weakness of the perichondral ring.
SCFE is the most common hip disorder in adolescence.
The femoral epiphysis remains in the acetabulum, while the
metaphysis move in an anterior direction with external
rotation.
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Etiology:
Increased force applied across the physis-1
2-Decrease in the resistance within the physis to shearing
3-Endocrinal factors ( HORMONAL IMBALANCE )
*** So there is a trigger ( Trauma mainly, Obesity, Physical
stress) + Underlying abnormality Caused slippage of the
proximal femur epiphysis.
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Epidemiology :
Boys are affected more often than girls.
SCFEs often occur in :
1-In obese children or tall (tow third of patent)
2-males (male to female ratio is 2:1.4)
3-during period of rapid growth (10-16 years of age)
If one side slips there is a 30% risk of the other side slipping as well.
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Presentation:
classification :
Based on onset of symptom:
***Chronic (>3 weeks): most common
-Aching groin, hip, thigh or knee pain and limp
- - Often no history of trauma
***Acute (<3 weeks):
Severe hip pain, inability to walk usually after trauma
Functional classification:
--stable :allow patent to walk with or without crutches(walking
aid)
--unstable :do not allow patent to ambulate at all regardless of
duration of symptom , this case carry a higher risk of complication
particularly AVN(avascular necrosis)
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Morphological classification:
*Mild vs moderate vs. severe depends on displacement
of epiphysis in relation to the diameter of the femoral
neck.on lateral view depend on the angle.
-Mild displacement: displacement of less than one-
third the width of the epiphysis (0-30 degree)
-Moderate displacement: displacements of one third to
one-half the epiphyseal width (30-60 degree)
- Severe displacement: if the displacement is more
than one-half the epiphyseal width(60-90 degree)
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Clinical features:
The patient presents with gradual, progressive onset
of pain in the groin, the anterior part of the thigh or
the knee (referred pain); he may also limp.
On examination the leg is externally rotated and is 1
or 2 cm short.
* Characteristically there is limitation of Flextion
abduction and medial (internal) rotation. Following an
acute slip, the hip is irritable and all movements are
accompanied by pain.
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Diagnosis :
By pelvic Xray
*AP radiograph: Klein line is a line drawn along
the superior border of the femoral neck that
would normally pass through a portion of the
femoral head. If not, slipped capital femoral
epiphysis is diagnosed. → Trethowan's sign
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* Frog leg radiograph (lateral):
Is diagnostically more reliable; even minor degrees of
slip can be shown by drawing lines through the base of
the epiphysis and up the middle of the femoral neck – if
the angle indicated is less than 90 degrees, the
epiphysis has slipped posteriorly.
-note :
A straight line through the center of the femoral neck
proximally should be at the center of the epiphysis. If
not, and the line is anterior in the epiphysis, it is likely
an SCFE.
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Complications:
1-Slipping at the opposite hip
occurs in one-third of cases.
2-Avascular necrosis is the most
serious complication,diagnosis by MRI
3-Coxa vara deformity may result if
the displacement is not reduced
and the epiphysis fuses in its
deformed position. The patient limps but the condition is usually painless. Osteotomy may be needed to correct the deformity.
4-chondrolysis : necrosis of the articular cartlage can progress to sever pain ,decreased range of motion .
5-osteoarthritis
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Treatment :
- Surgery, either In situ fixation using
screws or osteotomy if there's
deformity.
- Closed reduction is dangerous and
should not be attempted
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Thank you