Slipped Capital Femoral Epiphysis

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Definition

-  Slippage of femoral epiphysis due to fracture (Salter-Harris Type 1)

 

Features

-  Typically presents aged 10-15yrs

-  Boys 12-15yrs

-  Girls 10-13yrs

-  Male 3:2 female

-  Incidence 3:100,00

-  Increased risk in hypothyroidism, panhypopituitarism, hypogonadism

-  Bilateral 30%

-  Left > right

-  60% presentations chronic

-  15% acute, 25% acute on chronic

 

Cause

-  Physiological

-  Trauma

-  Obesity

-  Other (rare)

-  Hormonal disorders

-  Metabolic bone disease

-  Bone dysplasia

-  Radiotherapy

 

Assocaited S/S

-  Limp

-  Knee pain

-  Obesity

-  External rotation & shortening of limb

-  Muscle wasting

 

Ix

-  BMI

-  X-Ray Hips bilateral

-  Determine grade of slippage

-  Type I: <33% displacement

-  Type II: 33-50% displacement

-  Type III: >50% displacement

 

Complications

-  Avascular necrosis

-  Chondrolysis

-  Recurrence

-  OA (late)

-  50% at 50yrs will require hip replacement

 

Mx

-  Analgesia: NSAIDs..

-  Open internal fixation (single canulated screw)

 

 

 

References

 

emedicine.medscape.com/article/91596-overview