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Henry Yurianto, M.Phill, PhD, Sp.OT Orthopaedic and Traumatology Department Medical Faculty of Hasanuddin University Makassar 2012
BACKGROUND
Slipped capital femoral epiphysis (SCFE) is a common
hip disorder in adolescents. SCFE is characterized by posteroinferior displacement of the capital femoral epiphysis on the metaphysis through the physis.
Racial differences in the prevalence of SCFE : 1.0 for Caucasians, 4.5 for Pacific Islanders, 0.5 for Indonesian-Malay peoples
ETIOLOGY
Biomechanical
Obesity Femoral retroversion Trauma
Biochemical
Hormonal Imbalance
PATHOLOGY
Femoral head in contact with acetabulum Femoral shaft and neck rotate externally
Head moves posteriorly
DEGREE OF SLIP
Chronic SCFE
Symptom
85% of SCFE Patient Pain in the groin,thigh, or knee and walks with a limp. The duration of symptoms, although variable, lasts >3
flexion. When flexed up, the hip tends to move in an externally rotated position. There is a shortening of the affected leg. Atrophy of the thigh muscle may be noted
chronic SCFE develops a sudden acute exacerbation of pain that precludes walking
Stable SCFE
Unstable SCFE
Stable Weight Bearing Severity of slip Effusion Good Prognosis AVN Weight bearing possible Less severe Absent 96% 0%
Unstable Weight bearing not possible More severe Present 47% 50%
DIAGNOSIS
Physical Examination
History Taking Imagine
Diagnosis
IMAGINE
X-ray
AP and frog-leg lateral pelvis radiographs demonstrate the
IMAGINE
The second classification method measures the epiphyseal
The degree of slip is classified as : Mild (<30), Moderate (30 to 50), Severe (>50)
MANAGEMENT
Initial Treatment
Single screw fixation Bone Graft epiphysiodesis In situ fixation with multiple pins Hip spica cast
Late Treatment
Intertrochanteric osteotomy
MANAGEMENT
Single Screw Fixation
Percutaneous
placement with minimal soft-tissue injury High success rate and patient satisfaction rate A low incidence of slip progression, osteonecrosis, and chondrolysis. Karol et al reported that singlescrew fixation was 77% as stable as double screw fixation.
MANAGEMENT
Bone Graft Epiphysiodesis
Avoid
MANAGEMENT
In situ fixation with multiple pins
Multiple pins are placed in the posterosuperior
quadrant, the lateral epiphyseal vessels may be damaged. the frequency of complications with multiple pins is too high and do not recommend multiple pin fixation for the management of SCFE
MANAGEMENT
MANAGEMENT
Hip Spica Cast Not Recommended Pressure sores, Chondrolysis, Further slip after spica removed
MANAGEMENT
Prophylactic Fixation of the Contralateral Hip
The risk of contralateral SCFE developing in a patient
with unilateral SCFE is reported to be 2,335 times higher than the risk of initial SCFE. Prophylactic fixation of the contralateral hip was beneficial to the long-term outcome of that hip.
MANAGEMENT
A severe slip can be treated by fixing it and then performing a compensatory osteotomy. Wedges are cut based laterally and anteriorly so as to permit valgus, flexion and rotation at the osteotomy.
COMPLICATION
OSTEONECROSIS
Associated with manipulation of SCFE
Risk Factors : Severity of slip, reduction attempts, multiple screws,
high osteotomies.
On physical examination, Loss of hip motion, internal rotation,
Radiographs Collapse of the epiphysis with cyst formation Sclerosis develop after a few months
COMPLICATION
CHONDROLYSIS Rapid progressive loss of articular cartilage (joint space on xray) which is associated with pin penetration and multiple pin fixation. The incidence of chondrolysis in patients with SCFE ranges from1.8% to 55%, The diagnosis is confirmed by radiographs demonstrating a joint space reduction >50% a joint space <3 mm. Incidence now less with single pin fixation and reported to not occur with temporary penetration of the guide wire during screw fixation. Thought to be in autoimmune phenomenon.
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