Slipped capital femoral epiphysis (SCFE)

Separation of the proximal femoral epiphysis through the *growth plate*, leading
to medial and posterior displacement of the femoral head (relative to thefemoral neck). May be due to an imbalance between growth hormone and sex hormones.
Separation of the proximal femoral epiphysis through the *growth plate*, leading
to medial and posterior displacement of the femoral head (relative to thefemoral neck). May be due to an imbalance between growth hormone and sex hormones.
Obesity is the mainly risk factor
-Separation through growth plate of femoral epiphysis from metaphysis

-Risk factors = adolescent, obese, black race, hypothyroidism

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Risk factors: include *obesity*, age 11-13, male gender, and African-American ethnicity.

Associated with hypothyroidism and other endocrinopathies.

Hint: Obesity, limp, adolescent Think!! “Slipped capital femoral epiphysis”
H/P = thigh and knee pain; limp, limited internal rotation and abduction of the hip, hip flexion produces obligatory external hip rotation
HISTORY/PE
■ Typically presents with acute or insidious thigh or *knee pain and a painful limp.*
■ Acute cases present with restricted ROM and, commonly, *inability to bear weight.*
■ Bilateral in 40-50% of cases.
■ Characterized by limited internal rotation and abduction of the hip. Flexion of the hip results in an obligatory external rotation 2° to physical displacement that is observed as further loss of internal rotation with hip flexion.
Radiology = 
a. x-rays indicate posterior and medial displacement of the femoral head from the femoral metaphysis

DIAGNOSIS
■ Radiographs of *both hips in AP and frog-leg lateral views* reveal posterior and medial displacement of the femoral head 
■ Rule out hypothyroidism with TSH.
Radiology =
a. x-rays indicate posterior and medial displacement of the femoral head from the femoral metaphysis

DIAGNOSIS
■ Radiographs of *both hips in AP and frog-leg lateral views* reveal posterior and medial displacement of the femoral head
■ Rule out hypothyroidism with TSH.

TREATMENT
a. *surgical pinning*
b. weight -bearing restrictions prior to repair if unstable (unable to bear -weight on presentation
c. prophylactic pinning of normal contralateral side performed in cases of hypothyroidism
(Closed reduction of acute slips prior to pinning is controversial)
TREATMENT
a. *surgical pinning*
b. weight -bearing restrictions prior to repair if unstable (unable to bear -weight on presentation
c. prophylactic pinning of normal contralateral side performed in cases of hypothyroidism
Complications = increased risk of avascular necrosis (AVN) and premature osteoarthritis if treatment is not performed early
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