this is one of the interested subject in orthopedic, i presented it during my residency in Orthopedic programme KSA- R1

1. Slipped Capital
Femoral
Epiphysis
Dr. Fahad Al Hulaibi 2015
Orthopedic Surgery
National Guard Hospital-KSA

2. OPD PIC.

3. What is SCFE ??
Disorder of:
proximal femoral physis
that leads to slippage of the epiphysis
relative to the femoral neck

4. Risk factors
 obese children
 Males
 Age 10-16 y/o Campbell
 +ve family history
 Endocrinopathy. < 10 y/o
 Lt. hip is more common Campbell

5. In which zone of physis ?

6. Causes:
 local trauma.
 inflammatory conditions.
 Endocrine disorders (e.g., hypothyroidism,
hypogonadisim, hypopituitarism, and chronic renal
disease)
 genetic factors,
 Down syndrome
It is a multifactorial

7. presentation
 Boy : Girl ( 2:1 ) Campbell
 Knee pain (15-23%), thigh or groin pain.
 Limping. (if stable)
 symptoms usually for weeks to several
months.
 Thigh atrophy.

8. obligatory external rotation

9. X-ray Finding

10. AP & frog lateral

11. Klein's line
 Dr. saleem patient
 blurring of proximal femoral metaphysis
 epiphyseal plate seems to be too wide
 and too ‘lucent’

12. “blanch” sign

13. CT
 Do we need CT ?

14. Classifications

15. Stability by Loder et al.
 Stable:
can bear weight
 Un-stable
can’t bear Wight >> 47% ? AVN

16. Chronicity Campbell
 Acute:
Symptoms < 2 weeks
 Chronic:
Symptoms > 2 weeks
 Acute on chronic:
> 4 weeks with recent sudden exacerbation

17. Southwick Angle Classification
 Mild:
< 30 °
 Moderate:
30 ° - 60 °
 Severe:
> 60 ° Head shaft angle
In frog lateral view

18. Grading System Campbell
 Grade I :
0-33 % of slippage
 Grade II :
30-50 % of slippage
 Grade III :
> 50 % of slippage

19. TREATMENT

20. percutaneous in situ fixation
 In all stable and unstable slip.
 Goal:
- To stabilize the epiphysis from further slippage.
- Avoiding the complications.
 One screw or 2 ??

23. POSTOPERATIVE CARE
 discharged the same day.
 partial weight-bearing crutch (2 to 3 wks)
for stable only
 rigorous sports limited until the physes
have closed.
 Screw removal is not necessary.

24. contralateral in situ
prophylactic pinning ??

25. If one side affected..
25-40% the other one will be
Benson EC, Miller M, Bosch P, Szalay EA. A new look at the incidence of slipped capital femoral epiphysis
in new Mexico. J Pediatr Orthop. 2008 Jul-Aug. 28(5):529-33
12 to 18 months of the initial slip

26. increased incidence
 Endocrine abnormalities
 Age < 10 y/o
 for whom reliable follow-up is not feasible.
 high risk factors for complications.
 “posterior sloping” angle of more than 12
degrees

28. CLOSED REDUCTION
 slips treated without reduction.
 Only sever unstable acute Slip.

29. OPEN REDUCTION
 if a severe acute or chronic slip cannot be
reduced closed.

30. OSTEOTOMY

31. COMPLICATIONS
COMPLICATIONS

32. OSTEONECROSIS
 Common in unstable.
 Superolateral placement of pins

33. CHONDROLYSIS
 a joint space less than 3 mm wide
(normal 4 to 6 mm)
 decreased range of motion of the hip joint

34.  Most serous complication.
 Most painful.
 End with Ankylosis of hip joint.
 Tx: ??

35. FEMORAL NECK FRACTURE

36. Message is:
avoiding drilling
unnecessary
holes in the bone
during surgery

37. CONTINUED SLIPPING
 Patients who refused treatment.
 Pins were not placed far enough proximally.
 Remove pins before the physis had fused
completely

38. If you want a dream, Dream Big !!