Slipped capital femoral epiphysis
-
Upload
fahad-alhulaibi -
Category
Health & Medicine
-
view
678 -
download
0
Transcript of Slipped capital femoral epiphysis
Slipped Capital
Femoral
Epiphysis Dr. Fahad Al Hulaibi 2015
Orthopedic Surgery
National Guard Hospital-KSA
What is SCFE ?? Disorder of:
proximal femoral physis
that leads to slippage of the epiphysis
relative to the femoral neck
Risk factors
obese children
Males
Age 10-16 y/o Campbell
+ve family history
Endocrinopathy. < 10 y/o
Lt. hip is more common Campbell
Causes: local trauma.
inflammatory conditions.
Endocrine disorders (e.g., hypothyroidism, hypogonadisim, hypopituitarism, and chronic renal disease)
genetic factors,
Down syndrome
It is a multifactorial
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.
Klein's line
Dr. saleem patient
blurring of proximal femoral metaphysis
epiphyseal plate seems to be too wide
and too ‘lucent’
Chronicity Campbell
Acute:
Symptoms < 2 weeks
Chronic:
Symptoms > 2 weeks
Acute on chronic:
> 4 weeks with recent sudden exacerbation
Southwick Angle Classification
Mild:
< 30 °
Moderate:
30 ° - 60 °
Severe:
> 60 °
Head shaft angle
In frog lateral view
Grading System Campbell
Grade I :
0-33 % of slippage
Grade II :
30-50 % of slippage
Grade III :
> 50 % of slippage
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 ??
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.
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
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
CHONDROLYSIS
a joint space less than 3 mm wide
(normal 4 to 6 mm)
decreased range of motion of the hip joint
CONTINUED SLIPPING
Patients who refused treatment.
Pins were not placed far enough proximally.
Remove pins before the physis had fused
completely