Slipped Capital Femoral Epiphysis

Abstract

Slipped capital femoral epiphysis (SCFE) is the most common pediatric hip disease that affects patients of 10–14 years old. It is defined by posterior and inferior displacement (through the epiphyseal plate) of the proximal femoral epiphysis in relation to the metaphysis. Each year in the USA, approximately 10.8 cases per 100,000 children of SCFE occur, and 18–50% of cases are bilateral. The etiology of SCFE is multifactorial and includes endocrine disorders, growth spurs, and obesity. SCFE could be classified into acute, acute on chronic, and chronic forms, based on symptom duration. The Loder classification divides SCFE into stable or unstable form, based on the patient’s capacity to bear weight, with or without crutches. The most common symptoms are limping and pain localized to the hip, groin, thigh, or knee. The clinical diagnosis needs to be confirmed by a radiographic evaluation with anteroposterior and frog leg views.

In stable SCFE, the standard procedure is in situ closed fixation with a single screw. The unstable SCFE is related to a higher risk of osteonecrosis, and the standard treatment is in situ open fixation. The most commonly used method is the modified Dunn procedure, followed by triplane proximal femoral osteotomy.