Slipped Capital Femoral Epiphysis (SCFE)

SCFE: Slipped Capital Femoral Epiphysis

SCFE, also pronounced as “skiffy”, is known as atraumatic fracture of the hypertrophic zone of the physeal plate of the femoral capital epiphysis. Typically, SCFE displays itself in only one hip while the other is normal. It if more than twice as common in males than females at a ratio of 2.5:1. In males, SCFE is mostly expressed between the ages 10-16 and 12-14 in females. A common patient with SCFE is overweight and it is more common for black patients than white patients.

SCFE can be associated with the following:

  • malnutrition
  • DDH
  • endocrine abnormality
  • delayed skeletal maturation
  •  trauma
  • prior radiation
  • renal osteodystrophy
  • rickets

5-7% of cases demonstrate familial involvement. If the patient is under 10 years old or bilateral, then an underlying metabolic abnormality should be considered. SCFE can be bilaterial

Presentation:

  •  Acute to subacute (2-3 week history) of hip (50%) or knee (25%) pain.
  •  Insidious onset of limp or decreased range of motion

Pathophysiology

  • Expansion of the zone of hypertrophy up to 80% of the physeal plate (normal 15-30%)
  • Abnormal cartelidge maturation disrupting the normal palisading architecture

Classification

  • Preslip
  • Acute (<3 weeks)
  • Chronic (>3 weeks)

Preslip Symptoms:

  1. Widening of the epiphyseal plate with irregularity and blurring of the physis
  2. Demineralization of the femoral neck metaphyseal region
  3. Posterior and Medial displacement of the femoral head
  4. Decrease in neck shaft angle with change in alignment of the growth plate to a more vertical orientation

Acute Symptoms:

  1. Posterior and Medial displacement of the femoral head
  2. Decrease in neck shaft angle with change in alignment of the growth plate to a more vertical orientation
  3. Failure of the Line of Klein to intersect the femoral head
  4. Epiphysis may appear smaller to to posterior slippage

Chronic Symptoms:

  1. Sclerosis and widening of the epiphyseal plate

Patients can experience stable SCFE and are able to bear weight on their limb without assistive devices, however some patients are unstable and are unable to bear weight at all and is usually secondary to pain.

SCFE is classified by grades:

  • grade I – less than 33% displacement of head
  • grade II – 33-50% displacement of head
  • grade III – more than 50% displacement of head

Treatment Options:

  • Internal Fixation using percutaneous pin fixation.
  • early stabilization of hip
  • results in physeal closure
  • alleviates symptoms

Complication

AVN – initial event or  secondary to reduction

20-50% with attempted reduction

5% without attempt