Slipped Capital Femoral Epiphysis

Slipped Capital Femoral Epiphysis is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

Slipped capital femoral epiphysis (SCFE) is displacement of the femoral head (epiphysis) relative to the femoral neck (metaphysis).

Epidemiology

  • Most common adolescent hip disorder
  • Male > female (3:2)
  • Up to 25% bilateral at presentation
  • 20–40% have contralateral involvement at some point.

Incidence

  • 2 to 7 per 100,000
  • Age of onset: males 13 to 15 years; females 11 to 13 years

Risk Factors

Genetics

No clear genetic predisposition to SCFE

Pathophysiology

  • Stress across the proximal femoral physis results in slippage of the femoral neck relative to the head.
  • Weakening of the perichondrial ring and physis have been implicated.
  • The femoral head maintains its position within the acetabulum, whereas the femoral neck displaces anteriorly and more commonly superolaterally (varus).
  • In some cases, the neck displaces inferomedially (valgus).

Etiology

  • Stress on the proximal femoral physis from increased body weight, femoral retroversion, or inclination of the physis
  • Abnormal bone metabolism secondary to endocrinopathy or renal disorders
  • Toxicity to the physis from prior radiation or chemotherapy

Commonly Associated Conditions

  • Obesity
  • Endocrine dysfunction
    • Hypothyroidism
    • Hypopituitarism
    • Hyperparathyroidism
  • Growth hormone replacement therapy
  • Pelvic radiotherapy
  • Renal osteodystrophy

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