SCFE

Question 1

What is SCFE?

Answer 1

The metaphysis of the femur slips forwards off the capital femoral epiphysis. The ball ends up more and more posteriorly

Question 2

What is an acute SCFE?

Answer 2

May have some prodrome sx, but mostly a sudden instability and pt is unable to bear weight (acts like a fracture)

When you are unable to bear weight it is UNSTABLE

Radiographic images look abrupt and bone looks like it has slipped out of place

Question 3

What is a chronic SCFE?

Answer 3

A slow process, can occur over months, of sx but the patient is still able to walk and bear weight. STABLE

Radiographic images show it angled off, some bone subtracted/remodeled

Question 4

Are SCFE pts likely to be obese?

Answer 4

YES. Most common contributor. The vast majority are obese.

Hypogonadic/Adiposogenital syndrome
—They have so much adipose that its a reservoir for estrogen/production of estrogen by cholesterol precursors, and so they are hypogonadic and this affects the strength of the growth plate

Question 5

What age is SCFE commonly seen in?

Answer 5

Ages 11-16

Children getting near to the end of their growth

Question 6

Is SCFE more common in males or females?

Answer 6

M>F 4:1

Question 7

______ of SCFE are BL

Answer 7

20% are BL

Question 8

Why does SCFE happen?

Answer 8

MECHANICAL: There is a mismatch between the force applied to the growth plate and to the proximal femur
—Can be abnormally large forces on a normal growth plate
—Can be normal forces on weakened growth plate

1. Obesity
2. Age related changes to physeal strength
3. Decreased femoral anteversion
4. More vertical physis— as you age the physis gets more vertical, so the same force thats been there can now cause more sheering and slipping.

Question 9

What are other causes of SCFE that you need to investigate?

Answer 9

Endocrine issues:
—Hypothyroidism
—Growth hormone deficiency
—Renal failure (hyperparathyroidism)
—Hypopituitarism 
—Brain tumors
—Pituitary adenoma 
***all these things can present to ortho as a SCFE

Be suspicious when someone doesnt seem to meet the typical demographics: obese, younger age etc

Question 10

SCFE Presentation

Answer 10

1. Hip, groin, thigh, or KNEE pain— knee pain most commonly missed
2. Limp/Lurch
   —Antalgic limp (get off hip quicker d/t pain)
   —Lurch over the affected side
3. Externally rotated foot— as metaphysis slips forward the leg becomes externally rotated

Gradual onset but can be acute

Question 11

What X rays should you get for SCFE?

Answer 11

AP AND FROG lateral pelvis

—easy to miss, most is seen on lateral view

Question 12

What do Kleins lines look like?

Answer 12

On the AP view the Kleins lines run up the femoral neck. If a normal hip it should run through the epiphysis, in SCFE hip, the line is completely above the ball of the head of femur

Question 13

In Situ Pinning for SCFE

Answer 13

Put a pin into the center of the femoral head to reinforce the growth plate.
—Creates a physeal bar and prevents it from slipping further
—You are generally still accepting some level of deformity, you DO NOT FORCE the hip back into place (AVN risk), you just want to prevent further progression

Question 14

Open Dislocation Sx for SCFE

Answer 14

Done in certain CHRONIC cases that are very bad.
—See if the femoral head is still viable> if so, work on the metaphysis/remove some of it so that it can be reduced and screws placed

This is not the preferred method— higher risk of AVN

Question 15

What are the complications of SCFE?

Answer 15

—Precocious arthritis
—Labral tears
—Limited motion/Fxnl disability: bending over to put shoes on/sitting on toilet can be difficult; may need osteotomy to correct arc of motion of hip
—AVN from unstable SCFE or iatrogenic
—Chondrolysis; possibly iatrogenic or the screw could grind down the cartilage and cause debris and inflammation that causes a bad hip