MSK: Slipped Capital Femoral Epiphysis Flashcards
What is this condition?
A condition whereby the head of the femur, slips out of alignment due to shearing forces across the growth plate
In what direction does the epiphysis displace?
Posterior inferiorly
Why does it require prompt treatment?
To prevent avascular necrosis
In what age range is it most common?
10-15 years during the adolescent growth spurt
Is it more common in girls or boys?
Slightly more common in boys
Among what type of boys is it most common?
Obese boys
In at least 50% of cases the child’s weight is above the…
90th percentile
It is bilateral in what percentage of cases?
20%
There is an association with which disorders?
Metabolic endocrine disorders - hypothyroidism, hypogonadism
The capital femoral physis is displaced from the…
Metaphysis
What causes it?
Unknown, but thought to be due to mechanical forces on a susceptible physis
How does it present?
Limp
Hip pain that may refer to knee or groin
(Knee pain is often the only presenting complaint)
Describe the onset
May be acute, following minor trauma or insidious
What is found on examination?
Restricted abduction and internal rotation of hip Antalgic gait Externally rotated hip “out toeing” Affected leg may be shorter Thigh atrophy may occur
What is Drehmann sign?
Passive flexion of hip during external rotation
How is diagnosis confirmed?
X ray - AP and frog lateral views
Always x ray both sides
Are blood normal?
Yes
How is it managed?
Surgical - pin fixation to prevent slipping
Child kept non weight bearing until diagnosis made
What complications can occur?
Osteonecrosis - even with surgical treatment there is a risk
Chondrolysis
OA
Femoral acetabular impingement due to severe deformity of femoral neck
What view is most useful to make diagnosis?
Lateral
