Slipped Capital Femoral Epiphysis Surgery Workup

  • Author: Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho; Chief Editor: William L Jaffe, MD   more...
 
Updated: Mar 16, 2011
 

Laboratory Studies

  • A renal panel in patients with renal failure–associated slips may reveal elevated BUN and creatinine levels.
  • An endocrine panel is appropriate if endocrinopathy is suspected.
    • Hypothyroidism is a common endocrinopathy associated with slipped capital femoral epiphysis (SCFE). In cases in which hypothyroidism is suspected, triiodothyronine, thyroxine, and thyrotropin levels must be obtained.
    • Other endocrinopathies also may be associated with SCFE (see Pathophysiology). In these cases, the appropriate investigations must be performed.
Next

Imaging Studies

  • Diagnostic radiography
    • In the preslip stage, the only positive findings are a widening and irregularity of the physis with rarefaction of its juxtaepiphysial portion.
    • Early diagnosis is made using a Lauenstein (frog-leg) lateral view (see image below) or true lateral view of the hip because small slips may be missed on the anteroposterior (AP) view.[43] A frog-leg lateral view should not be attempted in persons with acute or unstable slips because it may cause further displacement. Frog-leg (Lauenstein) lateral view, showing a mildFrog-leg (Lauenstein) lateral view, showing a mild slip that can easily be missed on an anteroposterior view.
    • The Klein line, a line along the superior border of the femoral neck, intersects less of the femoral head than on the opposite side (Trethowan sign) on the AP radiograph (see image below).[12] Klein line (line drawn along the superior border oKlein line (line drawn along the superior border of the neck intersects less of the capital epiphysis than on the unaffected side).
    • Localized rarefaction of the inferior medial metaphysis of the neck may be evident.
    • The "metaphyseal blanch" of Steel is a crescent-shaped area of increased density overlying the metaphysis adjacent to the physis on the AP radiograph.[44] This is an early sign of a posterior slip without significant medial slip and indicates the need for a lateral radiograph to identify the slip.
    • In moderate-to-severe slips, the overlap of the head and the metaphysis is visible.
    • Remodeling in chronic slips is seen as callus on the posteroinferior portion of the neck and rounding-off of the anterosuperior bare area of the neck, which is seen as a rounded hump.
  • Bone scanning[45]
    • This can be used to identify patients at high risk of AVN. A cold bone scan (demonstrating an absence of vascularity) essentially is seen only in unstable cases. When a patient has such a bone scan finding, the risk of subsequently developing AVN is 80-100%.
    • Bone scans help in the early detection of AVN (ie, decreased activity/uptake on the femoral side).
    • These scans also help in the early detection of chondrolysis (ie, increased activity/uptake on both the acetabular and the femoral sides).
  • CT scanning
    • CT scanning can be used to measure the amount of retroversion and the degree of slip. Three-dimensional imaging of the upper femur, which may be useful in the preoperative planning of osteotomies, is also possible.
    • CT scans may incidentally reveal asymptomatic, mild, contralateral slips.
  • Ultrasonography
    • The presence of an effusion indicates an unstable slip.
    • The presence of remodeling indicates a stable slip.
  • MRI: This is used for early detection of AVN.
Previous
Next

Histologic Findings

In slipped capital femoral epiphysis (SCFE), the zone of hypertrophy is thickened, and the normal columnar arrangement of chondrocytes is lost. Chondrocyte clustering and disarray are evident.[46, 47]

Anatomically, the slip occurs in the layer of cartilage adjacent to the zone of provisional calcification (unlike a type 1 Salter-Harris injury, which occurs between the proliferating and the hypertrophic zones). However, the plane of cleavage may be irregular and may pass through different zones of the physis.

Ultrastructural studies show defective collagen fibrils and defects in collagen banding in the zone of hypertrophy and changes in the proteoglycan and glycoprotein concentrations in the zone of proliferation, with increased glycoprotein staining in the territorial matrix and increased proteoglycan staining in the extraterritorial matrix.[48]

Previous
Next

Staging

  • Traditional classification: This classification system of slipped capital femoral epiphysis (SCFE) may not be accurate and is not useful for prognosis.[49, 50, 51, 52, 53]
    • Preslip: Discomfort (pain and restricted internal rotation) is mild. The diagnosis is based primarily on radiological findings, with widening and irregularity of the physis and generalized osteopenia in the affected hemipelvis.[54] A scoring system for staging a pre-slip on the contralateral side has been developed.[42]
    • Acute slip (10-15% of cases): The duration of symptoms is less than 3 weeks, with no evidence of remodeling on the radiograph (see image below).[39, 51] Bilateral slipped capital femoral epiphysis. One sBilateral slipped capital femoral epiphysis. One side shows evidence of remodeling of the neck and an anterior bone bump that restricts flexion. The other side demonstrates an acute slip as seen by the absence of any evidence of remodeling.
    • Chronic slip (85% of cases): Symptoms persist for more than 3 weeks.[39]
    • Acute-on-chronic: An acute-on-chronic slipped capital femoral epiphysis is one associated with chronic symptoms initially and with subsequent development of acute symptoms, as well as a sudden increase in the degree of slip, usually with minor trauma.
  • Classifications based on stability: The focus of classification has shifted to determining the stability of the slip because stability significantly affects the prognosis. The classification into stable and unstable categories is important because it is predictive of the prognosis. The traditional classification of slips as acute or chronic is misleading because it does not take into account the stability of the hip, which is highly predictive of the development of AVN.
    • Loder classification[55]
      • The SCFE is considered stable when the child is able to walk with or without crutches.
      • SCFE is considered unstable when the child cannot walk with or without crutches.
    • Kallio classification: This radiographic classification depends on the presence or absence of a hip effusion on ultrasound images.[56, 57]
      • If the ultrasound images demonstrate the absence of metaphyseal remodeling and the presence of an effusion, an acute event is likely to have occurred, and the SCFE is considered unstable.
      • If the ultrasound images demonstrate metaphyseal remodeling and the absence of an effusion, an acute event has not occurred, and the SCFE is considered stable.
  • Classifications based on severity
    • Based on epiphyseal-metaphyseal angle: On a true lateral radiograph, the capital femoral epiphysis and the femoral neck usually lie at right angles to each other (up to 87° considered normal). The physeal-neck angle decreases proportionate to the amount of slip.
      • In mild cases, the neck is displaced less than one-third the diameter of the femoral head.
      • In moderate cases, one-third to one-half of the diameter of the femoral head is displaced.
      • In severe cases, displacement is more than half the diameter of the femoral head.
    • Based on the epiphyseal-shaft angle (angular measurement method): Depending on the epiphyseal-shaft angle (slip angle of Southwick), this classification is probably most important with regard to long-term prognosis (see image below).[58, 12] Mild and moderate slips have an excellent long-term prognosis when treated with in situ pinning, whereas severe slips are associated with a more rapid decline in hip function over time.[59, 60, 13] Southwick head-shaft angle (angle between the metaSouthwick head-shaft angle (angle between the metaphyseal surface of the physis and the shaft of the femur on a frog leg lateral view). Difference from the opposite side is used to grade the severity of the slip.
      • Mild is less than 30°.
      • Moderate is 30-60°.
      • Severe is more than 60°.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho  Assistant Professor of Orthopedic Surgery and Pediatrics, Thomas Jefferson University; Consulting Staff, Department of Pediatric Orthopedic Surgery, Alfred I duPont Hospital for Children; Orthopedic Oncologist, Helen F Graham Cancer Center and Christiana Care Health Services

Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho is a member of the following medical societies: Children's Oncology Group, Limb Lengthening and Reconstruction Society ASAMI-North America, Medical Council of India, and Musculoskeletal Tumor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Michael S Clarke, MD  Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven I Rabin, MD  Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

James J McCarthy, MD, FAAOS, FAAP  Associate Professor, Consulting Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health;

James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Orthopaedic Association, Limb Lengthening and Reconstruction Society ASAMI-North America, Orthopaedics Overseas, Pediatric Orthopaedic Society of North America, Pennsylvania Medical Society, Pennsylvania Orthopaedic Society, and Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William L Jaffe, MD  Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases

William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, and New York Academy of Medicine

Disclosure: Stryker Orthopaedics Consulting fee Speaking and teaching

References

  1. Schein AJ. Acute severe slipped capital femoral epiphysis. Clin Orthop. Mar-Apr 1967;51:151-66. [Medline].

  2. Segal LS, Weitzel PP, Davidson RS. Valgus slipped capital femoral epiphysis. Fact or fiction?. Clin Orthop. Jan 1996;(322):91-8. [Medline].

  3. Fraitzl CR, Nelitz M, Cakir B, Käfer W, Reichel H. Transfixation in Slipped Capital Femoral Epiphysis: Long-Term Evidence for Femoro-Acetabular Impingement. Z Orthop Unfall. Jun 2009;147(3):334-340. [Medline].

  4. Mamisch TC, Kim YJ, Richolt J, Zilkens C, Kikinis R, Millis M, et al. Range of motion after computed tomography-based simulation of intertrochanteric corrective osteotomy in cases of slipped capital femoral epiphysis: comparison of uniplanar flexion osteotomy and multiplanar flexion, valgisation, and rotational osteotomies. J Pediatr Orthop. Jun 2009;29(4):336-40. [Medline].

  5. Gholve PA, Cameron DB, Millis MB. Slipped capital femoral epiphysis update. Curr Opin Pediatr. Feb 2009;21(1):39-45. [Medline].

  6. Loder RT, Wittenberg B, DeSilva G. Slipped capital femoral epiphysis associated with endocrine disorders. J Pediatr Orthop. May-Jun 1995;15(3):349-56. [Medline].

  7. McAfee PC, Cady RB. Endocrinologic and metabolic factors in atypical presentations of slipped capital femoral epiphysis. Report of four cases and review of the literature. Clin Orthop. Nov 1983;(180):188-97. [Medline].

  8. Wells D, King JD, Roe TF, Kaufman FR. Review of slipped capital femoral epiphysis associated with endocrine disease. J Pediatr Orthop. Sep-Oct 1993;13(5):610-4. [Medline].

  9. Loder RT, Hensinger RN. Slipped capital femoral epiphysis associated with renal failure osteodystrophy. J Pediatr Orthop. Mar-Apr 1997;17(2):205-11. [Medline].

  10. Loder RT, Hensinger RN, Alburger PD, et al. Slipped capital femoral epiphysis associated with radiation therapy. J Pediatr Orthop. Sep-Oct 1998;18(5):630-6. [Medline].

  11. Castañeda P, Macías C, Rocha A, Harfush A, Cassis N. Functional outcome of stable grade III slipped capital femoral epiphysis treated with in situ pinning. J Pediatr Orthop. Jul-Aug 2009;29(5):454-8. [Medline].

  12. Green DW, Mogekwu N, Scher DM, Handler S, Chalmers P, Widmann RF. A modification of Klein's Line to improve sensitivity of the anterior-posterior radiograph in slipped capital femoral epiphysis. J Pediatr Orthop. Jul-Aug 2009;29(5):449-53. [Medline].

  13. Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. Jan-Feb 2009;29(1):1-8. [Medline].

  14. Kelsey JL, Acheson RM, Keggi KJ. The body build of patients with slipped capital femoral epiphysis. Am J Dis Child. Aug 1972;124(2):276-81. [Medline].

  15. Ninomiya S, Nagasaka Y, Tagawa H. Slipped capital femoral epiphysis. A study of 68 cases in the eastern half area of Japan. Clin Orthop. Sep 1976;(119):172-6. [Medline].

  16. Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop. Jan 1996;(322):8-27. [Medline].

  17. Murray AW, Wilson NI. Changing incidence of slipped capital femoral epiphysis: A RELATIONSHIP WITH OBESITY?. J Bone Joint Surg Br. Jan 2008;90(1):92-4. [Medline].

  18. Loder RT, Greenfield ML. Clinical characteristics of children with atypical and idiopathic slipped capital femoral epiphysis: description of the age-weight test and implications for further diagnostic investigation. J Pediatr Orthop. Jul-Aug 2001;21(4):481-7. [Medline].

  19. Burrow S, Alman B, Wright J. Relationship between short stature and endocrinopathy in slipped capital femoral epiphysis. Pediatrics. 1998;102(suppl):734.

  20. Abraham E, Gonzalez MH, Pratap S, Amirouche F, Atluri P, Simon P. Clinical implications of anatomical wear characteristics in slipped capital femoral epiphysis and primary osteoarthritis. J Pediatr Orthop. Oct-Nov 2007;27(7):788-95. [Medline].

  21. Galbraith RT, Gelberman RH, Hajek PC, et al. Obesity and decreased femoral anteversion in adolescence. J Orthop Res. 1987;5(4):523-8. [Medline].

  22. Gelberman RH, Cohen MS, Shaw BA, et al. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am. Sep 1986;68(7):1000-7. [Medline].

  23. Pritchett JW, Perdue KD. Mechanical factors in slipped capital femoral epiphysis. J Pediatr Orthop. Jul-Aug 1988;8(4):385-8. [Medline].

  24. Kordelle J, Millis M, Jolesz FA, et al. Three-dimensional analysis of the proximal femur in patients with slipped capital femoral epiphysis based on computed tomography. J Pediatr Orthop. Mar-Apr 2001;21(2):179-82. [Medline].

  25. Mirkopulos N, Weiner DS, Askew M. The evolving slope of the proximal femoral growth plate relationship to slipped capital femoral epiphysis. J Pediatr Orthop. May-Jun 1988;8(3):268-73. [Medline].

  26. Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. With special reference to the complication of osteoarthrosis. Acta Chir Scandinavica. 1939;58.

  27. Exner GU. Growth and pubertal development in slipped capital femoral epiphysis: a longitudinal study. J Pediatr Orthop. Jul-Aug 1986;6(4):403-9. [Medline].

  28. Morscher E. Strength and morphology of growth cartilage under hormonal influence of puberty. Animal experiments and clinical study on the etiology of local growth disorders during puberty. Reconstr Surg Traumatol. 1968;10:3-104. [Medline].

  29. Sorensen KH. Slipped upper femoral epiphysis. Clinical study on aetiology. Acta Orthop Scand. 1968;39(4):499-517. [Medline].

  30. Brenkel IJ, Dias JJ, Iqbal SJ, Gregg PJ. Thyroid hormone levels in patients with slipped capital femoral epiphysis. J Pediatr Orthop. Jan-Feb 1988;8(1):22-5. [Medline].

  31. Eisenstein A, Rothschild S. Biochemical abnormalities in patients with slipped capital femoral epiphysis and chondrolysis. J Bone Joint Surg Am. Jun 1976;58(4):459-67. [Medline].

  32. Mann DC, Weddington J, Richton S. Hormonal studies in patients with slipped capital femoral epiphysis without evidence of endocrinopathy. J Pediatr Orthop. Sep-Oct 1988;8(5):543-5. [Medline].

  33. Samuelson T, Olney B. Percutaneous pin fixation of chronic slipped capital femoral epiphysis. Clin Orthop. May 1996;(326):225-8. [Medline].

  34. Wilcox PG, Weiner DS, Leighley B. Maturation factors in slipped capital femoral epiphysis. J Pediatr Orthop. Mar-Apr 1988;8(2):196-200. [Medline].

  35. Hagglund G, Hansson LI, Ordeberg G. Epidemiology of slipped capital femoral epiphysis in southern Sweden. Clin Orthop. Dec 1984;(191):82-94. [Medline].

  36. Jerre R, Billing L, Hansson G, Wallin J. The contralateral hip in patients primarily treated for unilateral slipped upper femoral epiphysis. Long-term follow-up of 61 hips. J Bone Joint Surg Br. Jul 1994;76(4):563-7. [Medline].

  37. Jerre R, Billing L, Hansson G, et al. Bilaterality in slipped capital femoral epiphysis: importance of a reliable radiographic method. J Pediatr Orthop B. Spring 1996;5(2):80-4. [Medline].

  38. Dreghorn CR, Knight D, Mainds CC, Blockey NJ. Slipped upper femoral epiphysis--a review of 12 years of experience in Glasgow (1972-1983). J Pediatr Orthop. May-Jun 1987;7(3):283-7. [Medline].

  39. Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am. Aug 1993;75(8):1141-7. [Medline].

  40. Wilson PD, Jacobs B, Schecter L. Slipped capital femoral epiphysis: An end-result study. J Bone Joint Surg Am. Sep 1965;47:1128-45. [Medline].

  41. Riad J, Bajelidze G, Gabos PG. Bilateral slipped capital femoral epiphysis: predictive factors for contralateral slip. J Pediatr Orthop. Jun 2007;27(4):411-4. [Medline].

  42. Zide JR, Popejoy D, Birch JG. Revised Modified Oxford Bone Score: A Simpler Systemfor Prediction of Contralateral Involvement inSlipped Capital Femoral Epiphysis. J Pediatr Orthop. Mar 2011;31(2):159-64. [Medline].

  43. Loder RT. Effect of femur position on the angular measurement of slipped capital femoral epiphysis. J Pediatr Orthop. Jul-Aug 2001;21(4):488-94. [Medline].

  44. Steel HH. The metaphyseal blanch sign of slipped capital femoral epiphysis. J Bone Joint Surg Am. Jul 1986;68(6):920-2. [Medline].

  45. Rhoad RC, Davidson RS, Heyman S, et al. Pretreatment bone scan in SCFE: a predictor of ischemia and avascular necrosis. J Pediatr Orthop. Mar-Apr 1999;19(2):164-8. [Medline].

  46. Agamanolis DP, Weiner DS, Lloyd JK. Slipped capital femoral epiphysis: a pathological study. II. An ultrastructural study of 23 cases. J Pediatr Orthop. Jan-Feb 1985;5(1):47-58. [Medline].

  47. Ponseti IV, McClintock R. The pathology of slipping of the upper femoral epiphysis. J Bone Joint Surg Am. Jan 1956;38-A(1):71-83. [Medline].

  48. Agamanolis DP, Weiner DS, Lloyd JK. Slipped capital femoral epiphysis: a pathological study. I. A light microscopic and histochemical study of 21 cases. J Pediatr Orthop. Jan-Feb 1985;5(1):40-6. [Medline].

  49. Aadalen RJ, Weiner DS, Hoyt W, Herndon CH. Acute slipped capital femoral epiphysis. J Bone Joint Surg Am. Oct 1974;56(7):1473-87. [Medline].

  50. Aronson DD, Carlson WE. Slipped capital femoral epiphysis. A prospective study of fixation with a single screw. J Bone Joint Surg Am. Jul 1992;74(6):810-9. [Medline].

  51. Boyer DW, Mickelson MR, Ponseti IV. Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg Am. Jan 1981;63(1):85-95. [Medline].

  52. Fahey JJ, O'Brien ET. Acute slipped capital femoral epiphysis: Review of the literature and report of ten cases. J Bone Joint Surg Am. Sep 1965;47:1105-27. [Medline].

  53. Ward WT, Stefko J, Wood KB, Stanitski CL. Fixation with a single screw for slipped capital femoral epiphysis. J Bone Joint Surg Am. Jul 1992;74(6):799-809. [Medline].

  54. Ponseti I, Barta CK. The evaluation of treatment of the capital epiphysis. Surg Gynecol Obstet. 1948;86:87-97.

  55. Loder RT, Richards BS, Shapiro PS, et al. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. Aug 1993;75(8):1134-40. [Medline].

  56. Kallio PE, Paterson DC, Foster BK, Lequesne GW. Classification in slipped capital femoral epiphysis. Sonographic assessment of stability and remodeling. Clin Orthop. Sep 1993;(294):196-203. [Medline].

  57. Kallio PE, Mah ET, Foster BK, et al. Slipped capital femoral epiphysis. Incidence and clinical assessment of physeal instability. J Bone Joint Surg Br. Sep 1995;77(5):752-5. [Medline].

  58. Damaceno FL, Santili C, Longui CA. Normal reference values of Southwick's anteroposterior angle in prepubertal and pubertal normal adolescents. J Pediatr Orthop B. Nov 2007;16(6):389-92. [Medline].

  59. Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg Am. Jun 1991;73(5):667-74. [Medline].

  60. Carney BT, Weinstein SL. Natural history of untreated chronic slipped capital femoral epiphysis. Clin Orthop. Jan 1996;(322):43-7. [Medline].

  61. Betz RR, Steel HH, Emper WD, et al. Treatment of slipped capital femoral epiphysis. Spica-cast immobilization. J Bone Joint Surg Am. Apr 1990;72(4):587-600. [Medline].

  62. Aronson DD, Peterson DA, Miller DV. Slipped capital femoral epiphysis. The case for internal fixation in situ. Clin Orthop. Aug 1992;(281):115-22. [Medline].

  63. Strong M, Lejman T, Michno P, Sulko J. Fixation of slipped capital femoral epiphyses with unthreaded 2-mm wires. J Pediatr Orthop. Jan-Feb 1996;16(1):53-5. [Medline].

  64. Rao SB, Crawford AH, Burger RR, Roy DR. Open bone peg epiphysiodesis for slipped capital femoral epiphysis. J Pediatr Orthop. Jan-Feb 1996;16(1):37-48. [Medline].

  65. Weiner DS, Weiner S, Melby A, Hoyt WA Jr. A 30-year experience with bone graft epiphysiodesis in the treatment of slipped capital femoral epiphysis. J Pediatr Orthop. Mar 1984;4(2):145-52. [Medline].

  66. Schmidt TL, Cimino WG, Seidel FG. Allograft epiphysiodesis for slipped capital femoral epiphysis. Clin Orthop. Jan 1996;(322):61-76. [Medline].

  67. DeRosa GP, Mullins RC, Kling TF Jr. Cuneiform osteotomy of the femoral neck in severe slipped capital femoral epiphysis. Clin Orthop. Jan 1996;(322):48-60. [Medline].

  68. Velasco R, Schai PA, Exner GU. Slipped capital femoral epiphysis: a long-term follow-up study after open reduction of the femoral head combined with subcapital wedge resection. J Pediatr Orthop B. Jan 1998;7(1):43-52. [Medline].

  69. Barmada R, Bruch RF, Gimbel JS, Ray RD. Base of the neck extracapsular osteotomy for correction of deformity in slipped capital femoral epiphysis. Clin Orthop. May 1978;(132):98-101. [Medline].

  70. Kramer WG, Craig WA, Noel S. Compensating osteotomy at the base of the femoral neck for slipped capital femoral epiphysis. J Bone Joint Surg Am. Sep 1976;58(6):796-800. [Medline].

  71. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. Jul 1967;49(5):807-35. [Medline].

  72. Meier MC, Meyer LC, Ferguson RL. Treatment of slipped capital femoral epiphysis with a spica cast. J Bone Joint Surg Am. Dec 1992;74(10):1522-9. [Medline].

  73. Aronson DD, Loder RT. Slipped capital femoral epiphysis in black children. J Pediatr Orthop. Jan 1992;12(1):74-9. [Medline].

  74. Crawford AH. Osteotomies in the treatment of slipped capital femoral epiphysis. In: Instructional Course Lectures, American Academy of Orthopedic Surgeons. Vol 33. St. Louis, Mo: CV Mosby; 1984:. 327-49.

  75. Anand A, Chorney GS. Patient survey of weight-bearing and physical activity after in situ pinning for slipped capital femoral epiphysis. Am J Orthop. May 2007;36(5):E68-70; discussion E70. [Medline].

  76. de Sanctis N, Di Gennaro G, Pempinello C, et al. Is gentle manipulative reduction and percutaneous fixation with a single screw the best management of acute and acute-on-chronic slipped capital femoral epiphysis? A report of 70 patients. J Pediatr Orthop B. Spring 1996;5(2):90-5. [Medline].

  77. Peterson MD, Weiner DS, Green NE, Terry CL. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. Sep-Oct 1997;17(5):648-54. [Medline].

  78. Seller K, Raab P, Wild A, Krauspe R. Risk-benefit analysis of prophylactic pinning in slipped capital femoral epiphysis. J Pediatr Orthop B. Jul 2001;10(3):192-6. [Medline].

  79. Castro FP Jr, Bennett JT, Doulens K. Epidemiological perspective on prophylactic pinning in patients with unilateral slipped capital femoral epiphysis. J Pediatr Orthop. Nov-Dec 2000;20(6):745-8. [Medline].

  80. Ferguson AB, Howarth MB. Slipping of the upper femoral epipysis. A study of seventy cases. J Am Med Assn. 1931;97:1867-1872.

  81. Fish JB. Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. A follow-up note. J Bone Joint Surg Am. Jan 1994;76(1):46-59. [Medline].

  82. Dunn DM, Angel JC. Replacement of the femoral head by open operation in severe adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg Br. Aug 1978;60-B(3):394-403. [Medline].

  83. Crawford AH. Role of osteotomy in the treatment of slipped capital femoral epiphysis. J Pediatr Orthop B. Spring 1996;5(2):102-9. [Medline].

  84. Schai PA, Exner GU, Hansch O. Prevention of secondary coxarthrosis in slipped capital femoral epiphysis: a long-term follow-up study after corrective intertrochanteric osteotomy. J Pediatr Orthop B. Summer 1996;5(3):135-43. [Medline].

  85. Southwick WO. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. A technical improvement. J Bone Joint Surg Am. Sep 1973;55(6):1218-24. [Medline].

  86. Kennedy JG, Hresko MT, Kasser JR, et al. Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis. J Pediatr Orthop. Mar-Apr 2001;21(2):189-93. [Medline].

  87. Razzano CD, Nelson C, Eversman J. Growth hormone levels in slipped capital femoral epiphysis. J Bone Joint Surg Am. Sep 1972;54(6):1224-6. [Medline].

  88. Mandell GA, Keret D, Harcke HT, Bowen JR. Chondrolysis: detection by bone scintigraphy. J Pediatr Orthop. Jan 1992;12(1):80-5. [Medline].

 
Previous
Next
 
Valgus slip (rare).
Frog-leg (Lauenstein) lateral view, showing a mild slip that can easily be missed on an anteroposterior view.
Klein line (line drawn along the superior border of the neck intersects less of the capital epiphysis than on the unaffected side).
Southwick head-shaft angle (angle between the metaphyseal surface of the physis and the shaft of the femur on a frog leg lateral view). Difference from the opposite side is used to grade the severity of the slip.
Bilateral slipped capital femoral epiphysis. One side shows evidence of remodeling of the neck and an anterior bone bump that restricts flexion. The other side demonstrates an acute slip as seen by the absence of any evidence of remodeling.
Chronic slipped capital femoral epiphysis showing the extent of remodeling along the anterior neck (arrow).
Pin placement (anteroposterior view). A: The entry point must be at or above the level of the lesser trochanter to avoid the risk of subtrochanteric fracture. B: The pin (screw) should be in the center of the epiphysis. C: At least 2.5 threads engaging the epiphysis should be used for a secure hold.
Pin placement (lateral view). Arrow shows entry point in the anterolateral cortex.
Osteotomies in slipped capital femoral epiphysis (SCFE). A: Subcapital osteotomy. B: Base of the neck compensatory osteotomy. C: Intertrochanteric compensatory osteotomy. Note that the amount of correction increases from subcapital to intertrochanteric osteotomies.
Principle of the Dunn osteotomy. Reduction of the slip after shortening the neck to avoid stretch on the vessels and decrease the risk of avascular necrosis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.