Slipped capital femoral epiphysis: Difference between revisions
m (Rossdonaldson1 moved page Slipped Capital Femoral Epiphysis (SCFE) to Slipped capital femoral epiphysis) |
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*Most common cause of hip disability in adolescents | *Most common cause of hip disability in adolescents | ||
*Head of femur displaces from epiphysis | *Head of femur displaces from epiphysis | ||
*Complications: avascular necrosis, arthritis | *Complications: [[avascular necrosis]], [[arthritis]] | ||
===Risk Factors=== | ===Risk Factors=== | ||
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*Left hip more common | *Left hip more common | ||
*Associated with endocrine disorders | *Associated with endocrine disorders | ||
**Hypothyroid common | **[[Hypothyroid]] common | ||
**high clinical concern for <10 yrs of age | **high clinical concern for <10 yrs of age | ||
==Clinical Features== | ==Clinical Features== | ||
*Mild to severe pain hip pain (may have referred knee pain) | *Mild to severe pain [[Pediatric hip pain|hip pain]] (may have referred [[knee pain]]) | ||
*abnormal gait | *abnormal gait | ||
*Limp, weakness, thigh atrophy | *[[Limp (Peds)|Limp]], weakness, thigh atrophy | ||
*externally rotated | *externally rotated hip | ||
*loss of internal rotation, abduction, and flexion | *loss of internal rotation, abduction, and flexion | ||
*May present as acute, chronic, or acute on chronic (following trauma) | *May present as acute, chronic, or acute on chronic (following trauma) | ||
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==Common Complications== | ==Common Complications== | ||
* | *[[Avascular necrosis]] of femoral head; increased risk with high grade slip | ||
*contralateral SCFE | *contralateral SCFE | ||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
Revision as of 22:07, 24 December 2016
Background
- Abbreviation: SCFE
- Most common cause of hip disability in adolescents
- Head of femur displaces from epiphysis
- Complications: avascular necrosis, arthritis
Risk Factors
- Obesity
- Black patients
- Male:female (3:1)
- During growth spurt (m=13y f=11y)
- Left hip more common
- Associated with endocrine disorders
- Hypothyroid common
- high clinical concern for <10 yrs of age
Clinical Features
- Mild to severe pain hip pain (may have referred knee pain)
- abnormal gait
- Limp, weakness, thigh atrophy
- externally rotated hip
- loss of internal rotation, abduction, and flexion
- May present as acute, chronic, or acute on chronic (following trauma)
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Evaluation
- AP, Frog Leg Lateral View B/L
- Widened physis (early finding)
- Displacement of femoral neck to head (late finding)
- Frog Leg view of both sides: high proportion have b/l involvement
- Klein's line
- Line from superior cortex of femoral neck parallel to greater trochanter
- Normally should cross through 1/3 of femoral head
- Line from superior cortex of femoral neck parallel to greater trochanter
Management
- Orthopedic consultation in ED; pinning
- MRI for ambiguous cases
- Non-weight bearing
- Internal fixation
Common Complications
- Avascular necrosis of femoral head; increased risk with high grade slip
- contralateral SCFE
Disposition
- Admit
See Also
References
- Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
- AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009