Slipped capital femoral epiphysis
- Slipped capital femoral epiphysis
Slipped capital femoral epiphysis (SCFE) is a medical term referring to a fracture through the epiphyseal growth plate.
The capital (head of the femur) should sit squarely on the femoral neck. Abnormal movement along the growth plate results in the slip.
Often this condition will present in obese prepubescent males, especially young black males, and sometimes females with an insidious onset of thigh or knee pain with a painful limp. Hip motion will be limited, particularly internal rotation.
The Centers for Disease Control offers a body mass index (BMI) calculator to help determine a person's risk for obesity. [http://www.cdc.gov/nccdphp/dnpa/bmi/index.htm]
The disorder can sometimes be associated with endocrinopathies such as thyroid problems.
Classification
* Atypical
* Typical
* Stable
* Unstable
* Acute
* Chronic
Radiography
This disease warrants x-rays of the pelvis (AP and frog lateral). The appearance of the head of the femur in relation to the shaft likens that of a "melting ice cream cone". The severity of the disease can be measured using the Southwick angle.
Consultation with an orthopaedic surgeon is necessary to repair this problem. Untreated cases can result in serious growth abnormalities and permanent disability.
Many of these are treated with external in-situ pinning. Others such as Dr. Ganz advocate open reduction and pinning. The risk of reducing this fracture is disruption of the blood supply. Some also advocate pinning the unaffected side prophylactically.
ee also
*Legg–Calvé–Perthes syndrome - another cause of avascular necrosis of the femoral head, seen in younger children than SCFE.
References
Loder, R. Slipped Capital Femoral Epiphysis. American Family Physician 1998 57: 2135.
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