Slipped capital femoral epiphysis

Background

• head of femur displaces from epiphysis due to loss of mechanical integrity at the growth plate
• head of femur remains in acetabulum & femoral neck rotates anter
• may be seen in under 9, although uncommon (must investigate endocrinopathies in this subset)
• d/t slip of proximal femoral epiphysis post & inf on the metaphysis thru physeal plate during growth spurt
• 20% - 25% rate of opp hip involvement - 2/3 present at same time
• (33% - mild, 34-50 % mod. )50%-sev

Risk Factors

1. obesity
2. African American
3. male - female (2:1)
4. during growth spurt (m=13y f=11y)

Diagnosis

Age - 9 to 16 yrs

Present - mild to severe pain, limp

Presentation

1. acute, chronic or acute on chronic slippage.
2. pts tend to be overweight
3. limited range of motion on int rot Xrays
4. widened epiphyseal plate & displacement of femoral neck to head.
5. complications include jt space narrowing, arthritis & avascular necrosis of hip.

PE

rest - foot ext rotated, hip abducted & sl flexed to decr press. hip= decr int. Rotation, abduction, flexion on PE, waddling gate. Whitman's sign= get abduction & ext. Rotation of hip w/ flexion of knee.

Workup

Xray - Anterior displacement of femoral neck to head

• Loenstein (frog leg) view & AP views
• Kleines Line - line from sup cortex of femoral neck parallel to greater trochanter, nl= should cross thru 1/3 of fem head, scfe does'nt.
• X - ray - early - widened physis (B4 actual slip) if not sure do bone scan

Labs - normal

DDx

See Hip Pain

Treatment

1. Internal fixation
2. non wt bearing

Disposition

Admit for Ortho to pin b/c of risk of avascular necrosis w/o rx