Slipped Capital Femoral Epiphysis: Difference between revisions
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== Clinically Relevant Anatomy<br><br> == | |||
Slipped Capital Femoral Ephysis (SCFE) occurs in the adolescent population. It occurs when the femoral epiphysis slips posteriorly on the femoral neck at the physis. In actuality, the metaphysis of the femoral neck is displaced superiorly and anteriorly of the capital femoral epiphysis. <sup>1</sup> | Slipped Capital Femoral Ephysis (SCFE) occurs in the adolescent population. It occurs when the femoral epiphysis slips posteriorly on the femoral neck at the physis. In actuality, the metaphysis of the femoral neck is displaced superiorly and anteriorly of the capital femoral epiphysis. <sup>1</sup> | ||
== Mechanism of Injury / Pathological Process<br><br> == | == Mechanism of Injury / Pathological Process<br><br> == | ||
There are several factors that can contribute to developing a SCFE. The most widely recognized factor is obesity. It is hypothesiszed that as weight increases shearing forces across the physis are also increased causing it to weaken.<sup>1</sup> Other mechanical contributers to this condition are retroversion of the femur,and incresed physeal obliquity. Changes is hormone levels ( spikes in testosterone) during growth spurts can having a weakening effect on the physis.There is some association with endocrine disorders, however this is not a prevelent finding. <sup>1,2</sup> | There are several factors that can contribute to developing a SCFE. The most widely recognized factor is obesity. It is hypothesiszed that as weight increases shearing forces across the physis are also increased causing it to weaken.<sup>1</sup> Other mechanical contributers to this condition are retroversion of the femur,and incresed physeal obliquity. Changes is hormone levels ( spikes in testosterone) during growth spurts can having a weakening effect on the physis.There is some association with endocrine disorders, however this is not a prevelent finding. <sup>1,2</sup> | ||
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The preferred classification system is stable/unstable which is based on the weightbearing ability of the child. A classifcation of stable is given to those who can bear weight with/without an assistive device on the affected leg. Those who cannot are deemed unstable.<sup>1</sup> | The preferred classification system is stable/unstable which is based on the weightbearing ability of the child. A classifcation of stable is given to those who can bear weight with/without an assistive device on the affected leg. Those who cannot are deemed unstable.<sup>1</sup> | ||
== Clinical Presentation<br> == | == Clinical Presentation<br> == | ||
Typical presentation is a hild between the ages of 10 - 15 years and is m ore prevelant in malethan females (2:1 ratio). The child usually presents with some combination of hip,knee, thigh, and groin pain. The leg is typically externally rotated and an antalgic gait is noted. The majority of patients will be able to bear weight and will present with a limp. <sup>1,2 </sup>When testing hip range of motion , internal rotation is limited and all directions are painful. Typically, the invloved hip will fall into external rotation when the hip is passively flexed beyond 90<sup>0</sup>. <sup>1,2</sup> | Typical presentation is a hild between the ages of 10 - 15 years and is m ore prevelant in malethan females (2:1 ratio). The child usually presents with some combination of hip,knee, thigh, and groin pain. The leg is typically externally rotated and an antalgic gait is noted. The majority of patients will be able to bear weight and will present with a limp. <sup>1,2 </sup>When testing hip range of motion , internal rotation is limited and all directions are painful. Typically, the invloved hip will fall into external rotation when the hip is passively flexed beyond 90<sup>0</sup>. <sup>1,2</sup> | ||
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== Diagnostic Procedures == | == Diagnostic Procedures == | ||
Radiographs in both the Anterior/Posterior view and the "frog" postion of each hip is required.<sup>1,2</sup> The Wilson classification system utlizes the radiographs to classify a mild slip( less than 1/3 displacement), moderate slip ( between 1/3 - 1/2 displacement), and severe slip ( greater than 1/2 displacment).<sup>1</sup><br> | Radiographs in both the Anterior/Posterior view and the "frog" postion of each hip is required.<sup>1,2</sup> The Wilson classification system utlizes the radiographs to classify a mild slip( less than 1/3 displacement), moderate slip ( between 1/3 - 1/2 displacement), and severe slip ( greater than 1/2 displacment).<sup>1</sup><br> | ||
== Outcome Measures == | == Outcome Measures == | ||
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add links to outcome measures here (see <a href="Outcome Measures">Outcome Measures Database</a>) | add links to outcome measures here (see <a href="Outcome Measures">Outcome Measures Database</a>) | ||
== Management / Interventions<br> == | == Management / Interventions<br> == | ||
Surgical management of this condition is warranted due to the secondary complications of AVN or chondrolysis. A delay in diagnosis results in a less favorable prognosis. This can lead to long term effects such as OA and cam type impingement due to changes in the femoral neck.<sup>1 </sup>Surgical stabilization is performed by placing a screw/screws through the epiphysis to minimize displacement and maintain motion. <sup>1,2</sup><br> | Surgical management of this condition is warranted due to the secondary complications of AVN or chondrolysis. A delay in diagnosis results in a less favorable prognosis. This can lead to long term effects such as OA and cam type impingement due to changes in the femoral neck.<sup>1 </sup>Surgical stabilization is performed by placing a screw/screws through the epiphysis to minimize displacement and maintain motion. <sup>1,2</sup><br> | ||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
Other conditions to rule out: fractures, AVN, Legg-Calve Perthes, Osteomyelitis,Septic Arthritis, and groin pull. <sup>1</sup><br> | Other conditions to rule out: fractures, AVN, Legg-Calve Perthes, Osteomyelitis,Septic Arthritis, and groin pull. <sup>1</sup><br> | ||
== Key Evidence == | == Key Evidence == | ||
add text here relating to key evidence with regards to any of the above headings<br> | add text here relating to key evidence with regards to any of the above headings<br> | ||
== Resources <br> == | == Resources <br> == | ||
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== Case Studies == | == Case Studies == | ||
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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== References == | == References == | ||
1.Gholve P, Cameron D, Millis M. Slipped capital femoral epiphysis update. Current Opinion in Pediatrics 2009;21:39-45. | 1.Gholve P, Cameron D, Millis M. Slipped capital femoral epiphysis update. Current Opinion in Pediatrics 2009;21:39-45. | ||
2, Campbell S, Vander Linden D, Palisano R. Physical Therapy for Children. St. Louis, Missoouri:Elsevier Inc,2006. | 2, Campbell S, Vander Linden D, Palisano R. Physical Therapy for Children. St. Louis, Missoouri:Elsevier Inc,2006. | ||
[[Category:Articles]] [[Category:Condition]] [[Category:EIM_Student_Project_2]] [[Category:Hip]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Paediatrics]] | [[Category:Articles]] [[Category:Condition]] [[Category:EIM_Student_Project_2]] [[Category:Hip]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Paediatrics]] | ||
Revision as of 18:51, 9 November 2010
Original Editors
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
add text here related to databases searched, keywords, and search timeline
Definition/Description[edit | edit source]
add text here
Clinically Relevant Anatomy[edit | edit source]
add text here
Epidemiology /Etiology[edit | edit source]
add text here
Characteristics/Clinical Presentation[edit | edit source]
add text here
Differential Diagnosis[edit | edit source]
add text here
Diagnostic Procedures[edit | edit source]
add text here related to medical diagnostic procedures
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
add text here
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
Clinically Relevant Anatomy
[edit | edit source]
Slipped Capital Femoral Ephysis (SCFE) occurs in the adolescent population. It occurs when the femoral epiphysis slips posteriorly on the femoral neck at the physis. In actuality, the metaphysis of the femoral neck is displaced superiorly and anteriorly of the capital femoral epiphysis. 1
Mechanism of Injury / Pathological Process
[edit | edit source]
There are several factors that can contribute to developing a SCFE. The most widely recognized factor is obesity. It is hypothesiszed that as weight increases shearing forces across the physis are also increased causing it to weaken.1 Other mechanical contributers to this condition are retroversion of the femur,and incresed physeal obliquity. Changes is hormone levels ( spikes in testosterone) during growth spurts can having a weakening effect on the physis.There is some association with endocrine disorders, however this is not a prevelent finding. 1,2
There are several classification systems to determine the severity of a SCFE. One delinates the disorder into acute, acute-on-chronic, and chronic. Acute signifies the SCFE occured with trauma and results in immmediate pain and decreased hip ROM ( abduction and internal rotation). Acute-on chronic decsribes a patient having symptoms for months and then has an increased slip due to trauma. Chronic is identified as the most common presentation, and the child has had symptoms for several months.2
The preferred classification system is stable/unstable which is based on the weightbearing ability of the child. A classifcation of stable is given to those who can bear weight with/without an assistive device on the affected leg. Those who cannot are deemed unstable.1
Clinical Presentation
[edit | edit source]
Typical presentation is a hild between the ages of 10 - 15 years and is m ore prevelant in malethan females (2:1 ratio). The child usually presents with some combination of hip,knee, thigh, and groin pain. The leg is typically externally rotated and an antalgic gait is noted. The majority of patients will be able to bear weight and will present with a limp. 1,2 When testing hip range of motion , internal rotation is limited and all directions are painful. Typically, the invloved hip will fall into external rotation when the hip is passively flexed beyond 900. 1,2
Diagnostic Procedures[edit | edit source]
Radiographs in both the Anterior/Posterior view and the "frog" postion of each hip is required.1,2 The Wilson classification system utlizes the radiographs to classify a mild slip( less than 1/3 displacement), moderate slip ( between 1/3 - 1/2 displacement), and severe slip ( greater than 1/2 displacment).1
Outcome Measures[edit | edit source]
add links to outcome measures here (see <a href="Outcome Measures">Outcome Measures Database</a>)
Management / Interventions
[edit | edit source]
Surgical management of this condition is warranted due to the secondary complications of AVN or chondrolysis. A delay in diagnosis results in a less favorable prognosis. This can lead to long term effects such as OA and cam type impingement due to changes in the femoral neck.1 Surgical stabilization is performed by placing a screw/screws through the epiphysis to minimize displacement and maintain motion. 1,2
Differential Diagnosis
[edit | edit source]
Other conditions to rule out: fractures, AVN, Legg-Calve Perthes, Osteomyelitis,Septic Arthritis, and groin pull. 1
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Recent Related Research (from Pubmed)[edit | edit source]
Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1vqCZ1kRmpntYV4YLK0akSJO4lJIatWmLWDy0gSXgjYLDwLgeE|charset=UTF-8|short|max=10: Error parsing XML for RSS
References[edit | edit source]
1.Gholve P, Cameron D, Millis M. Slipped capital femoral epiphysis update. Current Opinion in Pediatrics 2009;21:39-45.
2, Campbell S, Vander Linden D, Palisano R. Physical Therapy for Children. St. Louis, Missoouri:Elsevier Inc,2006.
