Slipped Capital Femoral Epiphysis

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.

RISK-FACTORS

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

ASSOCIATED-CONDITIONS

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