undergraduate series orthopedics

1. SLIPPED CAPITAL
FEMORAL EPIPHYSIS
(SCFE)
NUR FARRA NAJWA BINTI ABDUL AZIM
082015100035

2. LEARNING OBJECTIVE
By the end of seminar, students should be able to
• Know in brief the anatomy of long bone related to SCFE
• Know the definition of SCFE
• List the risk factors, causes and pathogenesis of SCFE
• Explain the examination findings in SCFE
• List the investigations, and radiological findings in SCFE
• Explain the management and complication of SCFE

6. INTRODUCTION
• Displacement (“slip”) of femoral epiphysis through
proximal physis
• Slipped usually gradually, sometime occurs suddenly
• Upper femoral epiphysis get displaced at growth plate
o Posteriorly (to neck)
o Medially
o Causing coxa vara
o Still within acetabulum

7. ETIOPATHOGENESIS
CAUSES RISK FACTOR
• Unknown
• Maybe due to
trauma
• Common in unduly
obese and sexually
underdevelop
• Or tall thin, sexually
normal
• M>F
• Obese
• Adolescent
• Associated with
endocrinal diseases
• Hypogonadism
• Hypothyroidism
• Chronic renal
osteodystrophy

8. Susceptible
physis due to
perichondral ring
weakness
Weak physis at
puberty due to
circulating
gonadotropins
Weakened
physis
Physeal
separation :
SCFE
Epiphysis separated and stay
in acetabulum, neck rotate
anterior and externally
Growth
spurt
Obesity induce
stress at growth
plate

9. CLASSIFICATION
TEMPORAL
• Acute: slip within
3 weeks
• Chronic: slip > 3
weeks
• Acute on chronic
LODER
CLASSIFICATION
(Stability)
• Stable : able to weight
bearing
• Unstable : unable to
weight bearing
SOUTHWICK
ANGLE
• Mild: <30 degree
• Moderate : 30 –
50 degree
• Severe : >50
degree

11. CLINICAL FEATURE
1. Young
2. Pubertal age(12-14)
3. Boys common
4. Obese
5. 30% occur in both side
6. Some cases: definite history of trauma
7. Commonly has endocrine abnormality
Hx: 10-16 year old, obese, limp, hip & knee pain, (+/-)
weight bearing
Obese
Renal problem
Thyroid problem

12. PRESENTING WITH
1. Pain
1. Groin
2. Radiating to thigh
3. Mis-tought as sprain
4. Pain often dissappear then recur again
2. Limp (antalgic gait)
3. Difficult to weight bearing
4. Underlying endocrine disorder

14. EXAMINATION
• Lower limb
o External rotated
o Increases in adduction
o 1 to 2 cm short
• Loss of
o Internal rotation
o Flexion
o Abduction
• When hip flexed, knee
goes to ipsi-lateral axilla
• Limitation of hip
movement
• Muscle bulk reduced
• + Trendelenburg sign

17. INVESTIGATION
Plain Xray
MRI :
rarely
done
Rule out
endocrinal
causes

20. RADIOLOGICAL
FINDINGS
AP VIEW LATERAL VIEW
• Displaced growth plate to
metaphyseal side
• Trethowan sign
• Head angulated on neck
• If an anteroposterior view of the
hip joint is taken then a line
drawn along the superior surface
of the neck should pass through
the femoral head.
• If the line remains superior to the
femoral head then this is
termed Trethowan's sign.

22. AP VIEW AND FROG
LEG LATERAL VIEW
• Look for Klien line intersecting femoral head
• Increased Southwick angle
o Angle between shaft of femur and head of femur
o Angle measure bilaterally
o The angle slipped side is subtracted from normal side
o Mild: <30 degree
o Moderate: 30-50 degree
o Severe: >50 degree

23. TREATMENT
STABLE OR UNSTABLE
HIP:
•Percutaneous in situ
pinning with cancellous
screw
OTHER “NORMAL” HIP
• Observe/prophylactic
pinning

24. TREATMENT
ACUTE SLIP
• Closed reduction
and pinnnings
GRADUAL SLIP
•<1/3, epiphysis fixed
internally in situ
•>1/3, corrective
osteotomy
performed at
intertrochanteric
region
UNAFFECTED
SITE
• Prophylactic
pinning in
unaffected site

28. COMPLICATION
• Avascular necrosis
• Chondrolysis
• Secondary hip osteoarthritis

29. QUESTIONS

30. SUMMARY
• Know in brief the anatomy of long bone related to SCFE
• Know the definition of SCFE
• List the risk factor, causes and pathogenesis of SCFE
• Explain the examination finding in SCFE
• List the investigation, and radiological findings in SCFE
• Explain the management and complication of SCFE

31. REFERENCES

32. THANK YOU