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Abstract
Slipped capital femoral epiphysis (SCFE) is the most common hip abnormality presenting in adolescence and a primary cause of early osteoarthritis. (1) SCFE is defined as a posterior and inferior slippage of the proximal femoral epiphysis relative to the metaphysis; it occurs through the hypertrophic physeal zone. In actuality, the relationship of the epiphysis and its articular surface relative to the acetabulum does not change, and the slippage is better defined as an anterior and superior slippage of the proximal femoral metaphysis (neck) relative to the epiphysis. (2) More specific epidemiological data may provide valuable clues regarding the etiology of SCFE and may improve our ability to treat and prevent this condition. (3) In most children with SCFE, the precise etiology is unknown. Regardless of the underlying etiology. Conditions that weaken the physis include endocrine abnormalities, systemic diseases (such as renal osteodystrophy), and previous radiation therapy in the region of the proximal femur (Atypical SCFE). (4)
SCFE is classified as pre-slip, acute, chronic and acute on chronic (5),or classified as stable or unstable based on the stability (6), Kallio classification depends on the presence or obscene of a hip effusion by ultrasound images. (7) It is also classified as mild, moderate and severe based on epiphyseal shaft angle. (8)
A good history and physical examinations should be considered for all newly diagnosed cases of SCFE to elicit who are with high risk. (9)
Introduction Investigations done in SCFE are: 1-Laboratory investigations. ( like T3- T4- hGH- Cortisol- ACTH). 2-Radiographic investigations. (10)
Delay in diagnosis of slipped capital femoral epiphysis (SCFE) in the pediatric and adolescent hip has important implications in terms of long-term hip outcome. Delayed diagnosis is associated with increased slip severity. (11) The goals of treatment in SCFE are early detection prevention of further slipping, and avoidance of complications. Although attention is often focused on the affected hip, care of the unaffected hip (either through careful observation or through prophylactic treatment) cannot be forsaken. (12) Non-operative treatment by traction and spica cast immobilization has been reported to prevent further slipping. Methods of operative treatment of SCFE have included percutaneous and open in situ pinning, open reduction and internal fixation, epiphysiodesis, osteotomy, and reconstruction by arthrodesis. (13)
When diagnosed with unilateral SCFE, the patient and the clinician must decide between prophylactic in situ pinning and observation for the contralateral hip. Optimal management of the contralateral normal hip after unilateral SCFE is controversial. (14) Complications of SCFE may occur immediately or later. The late complications include osteoarthritis (OA), osteonecrosis (ON) and chondrolysis. (15)