Slipped capital femoral epiphysis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Slipped capital femoral epiphysis (SCFE) is a medical term referring to a fracture through the epiphyseal growth plate.

The capital (head of the femur) should sit squarely on the femoral neck. Abnormal movement along the growth plate results in the slip.

Often this condition will present in obese prepubescent males, especially young black males, and sometimes females with an insidious onset of thigh or knee pain with a painful limp. Hip motion will be limited, particularly internal rotation. The Centers for Disease Control offers a body mass index (BMI) calculator to help you determine your risk for obesity. [2]

The disorder can sometimes be associated with endocrinopathies such as thyroid problems.

Classification

Atypical Typical

Stable Unstable

Acute Chronic

Radiography

This disease warrants x-rays of the pelvis (AP and frog lateral). The appearance of the head of the femur in relation to the shaft likens that of a "melting ice cream cone". The severity of the disease can be measured using the Southwick angle.

On imaging, Salter-Harris type 1 fracture of the proximal femoral physis with posterior-medial displacement of the proximal femoral epiphysis is seen.

Patient #1: Radiographs demonstrate left slipped capital femoral epiphysis

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Patient #2: Radiographs demonstrate right slipped capital femoral epiphysis

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Consultation with an orthopaedic surgeon is necessary to repair this problem. Untreated cases can result in serious growth abnormalities and permanent disability.

Many of these are treated with in-situ pinning. Others such as Dr. Ganz advocate open reduction and pinning. The risk of reducing this fracture is disruption of the blood supply. Some also advocate pinning the unaffected side prophylactically.

References

Loder, R. Slipped Capital Femoral Epiphysis. American Family Physician 1998 57: 2135.