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Slipped Capital Femoral Epiphysis (SCFE) - Coggle Diagram
Slipped Capital Femoral Epiphysis
(SCFE)
syn
Epiphyseal coxa vara; Adolescent coxa vara
def
occurs during adolescent rapid growth period when epiphyseal plate is weak and the capital epiphysis is displaced down and back
(a type of fracture)
Müller first described it in 1889.
Theories of causations
Harris hormonal theory:
Due to hormonal imbalance
between the increased growth hormone and decreased sex and thyroid hormone.
Traumatic theory
Epiphyseal line is the weakest part of
the normal adolescent bone.
Theory of periosteal thinning
Periosteum, which is thick
in children, thins out during adolescence.
Etiology
Predisposing Factors
Age:
It is common in 10-17 years of age
Sex
Male : Female are 5:2 ratios.
Body type:
Female—slender long built, and
male— obesity type
Location:
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Clinical Features and Investigations
Acute
(11%):
Sudden onset and the symptoms are
less than two weeks duration
Chronic
(60%):
Symptoms are present for more than
two weeks. X-ray shows callus and remodeling
Acute on chronic
(23%):
Symptoms are present for
one month and there is a recent sudden increase in pain following trivial injury.
Preslip
(6%):
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Stages
Preslipping stage
discomfort in the groin
stiffness/limp
no objective finding
medial rotation of the hip is decreased
chronic-slipping stage
increasing pain
antalgic gait
all movements decreased sp abduction & int rotation
varus+adduction+ext rot deformity is present
shortening is present
extension & ext rot increased
waddling gait is present
tredelenberg 's gait is postitive
stage of fixed deformity
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Radiographic Changes
Early changes
Marginal blurring of the proximal metaphysis
.
. Lower margin of metaphysis is included within the acetabulum normally but excluded in the early epiphyseal slip
.
Trethovan’s line: Line drawn along the superior margin of the neck, transects the epiphysis normally but will be above
it in slip
.
Depth of epiphysis is reduced.
.
There is a step between the metaphysis and the epiphysis
Late changes
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Classification of Slipping
Mild slipping (51%):
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Principles of treatment
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