1. Slipped Capital Femoral Epiphysis SCFE
دکتر مظلومی
دانشیار ارتوپدی دانشگاه علوم پزشکی
مشهد

2. Slip Capital Femoral Epiphyses

3. INCIDENCE AND EPIDEMIOLOGY
The usual deformity consists of an upward and anterior movement of the femoral neck on the capital epiphysis.
The incidence of SCFE varies according to race,
sex, and geographic location: The incidence is estimated to be approximately 2 per 100,000 population,

4. INCIDENCE AND EPIDEMIOLOGY
There is a definite predilection for males to be
affected more often than females(5/1), and for the left hip to be affected more often than the right(3/1).
Slipped epiphysis typically occurs during adolescence (boys, 13 to 15 years of age, averaging about 14years; and girls, 11to 13years of age, averaging about 12 years) a period of maximal skeletal growth.

5. INCIDENCE AND EPIDEMIOLOGY
When SCFE occurs in a juvenile (10 years of age and younger) or in a patient with an open physis older than 16 years of age, careful assessment for an underlying Endocrinopathy should be considered.
Most studies identify bilateral involvement
either on initial presentation or subsequently in
approximately 20% to 25% of patients

6. CLASSIFICATION
According to onset of symptoms (acute, chronic, or acute-an-chronic)
functionally, according to the patient's ability to bear weight (stable or unstable)
or morphologically, as to the extent of displacement of the femoral epiphysis relative to the neck (mild, moderate, or severe),

7. CLASSIFICATION
An acute SCFE has been characterized as one occurring in a patient with prodromal symptoms for 3 weeks or less
Acute slips present as a sudden, dramatic,
fracture-like episode occurring after trauma too trivial to cause displacement of the epiphysis as a Salter- Harris type I fracture

8. CLASSIFICATION
Chronic SCFE is the most frequent form of presentation. Typically, an adolescent presents with a few months history of vague groin pain, upper or lower thigh pain, and a limp.
Radiographs of patients with chronic SCFE show a variable amount of posterior migration of the femoral epiphysis and remodeling of the femoral neck in the same direction

9. CLASSIFICATION
The acute-on-chronic slipped epiphysis is one in which features of both ends of the spectrum are present
prodromal symptoms have been present for more than 3 weeks with a sudden exacerbation of pain, and radiographic evidence of both femoral neck remodeling and further displacement

10. Classification Functional Classification
Patients who were unable to bear weight after the acute episode were identified as having unstable slips.
those who were able to bear weight at the time of presentation to a physician were classified as having stable slips

11. Morphologic Classification
Head-shaft angle
mild slips less than 30 degrees from the normal contralateral side
moderate slips the
angle difference is between 30 and 60 degrees
severe slips the angle differs by more than 60 degrees from the contralateral normal side.

12. ETIOLOGY Mechanical Factors THINNING OF THE PERICHONDRIAL RING COMPLEX
RELATIVE OR ABSOLUTE FEMORAL RETROVERSION
CHANGE IN INCLINATION OF THE ADOLESCENT PROXIMAL FEMORAL PHYSIS RELATIVE TO THE FEMORAL NECK AND SHAFT
ASSOCIATED CONDITIONS
Blount's disease , peroneal spastic flat foot and Legg-Calve-Perthes disease.

13. ETIOLOGY Endocrine Factors
The stereotype of an obese, hypogonadal male (the so-called adiposogenital syndrome) presenting with chronic bilateral slipped epiphyses has long stimulated the thought that some alteration in the balance of thyroid, growth, and sex hormones was the cause of slipped epiphysis

14. CLINICAL FEATURES Stable, Chronic Slipped Capital Femoral Epiphysis
pain in the region of the groin, which may be
referred to the anteromedial aspect of the thigh and knee.
The loss of internal rotation on examination, with complaints of pain at the limit of internal rotation, is a key finding in stable SCFE.

16. Unstable Acute or Acute-on-Chronic Slipped Capital Femoral Epiphysis
Clinical features
Unstable Acute or Acute-on-Chronic Slipped Capital Femoral Epiphysis
severe, fracture-like pain in the affected hip region, usually as the result of a relatively minor fall or twisting injury.
the patient unable to bear weight and likely to seek prompt medical attention.

17. RADIOGRAPHIC FINDINGS
Plain Radiography
AP and lateral views
(Klein's line) on the AP view

18. TREATMENT STABLE SLIPPED CAPITAL FEMORAL EPIPHYSIS
Percutaneous In Situ Fixation with a Fracture Table

20. treatment
Femoral neck osteotomy

21. COMPLICATIONS Chondrolysis 1- acute cartilage necrosis
2- stiffness and persistent pain in the groin Loss of joint space
3- The incidence of chondrolysis is 1.5%

22. Avascular Necrosis
The most severe complication associated with SCFE is the development of AVN of the epiphysis.