Slipped Capital Femoral Epiphysis: Difference between revisions

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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
'''Original Editor '''- [[User:Juliana Doyle|Juliana Doyle]], [[User:Brachotte Florence|Brachotte Florence]]  
'''Original Editor '''- [[User:Juliana Doyle|Juliana Doyle]], [[User:Brachotte Florence|Brachotte Florence]], [[User:Kirianne Vander Velden|Kirianne Vander Velden]]  


'''Lead Editors''' - Your name will be added here if you are a lead editor on this page.&nbsp; [[Physiopedia:Editors|Read more.]]  
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page.&nbsp; [[Physiopedia:Editors|Read more.]]  
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== Definition/Description  ==
== Definition/Description  ==


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&nbsp;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&nbsp;is displaced superiorly and anteriorly of the capital femoral epiphysis. <sup>1</sup>  


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==
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== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==


&nbsp;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&nbsp;hip,knee, thigh, and&nbsp;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>
&nbsp;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&nbsp;hip,knee, thigh, and&nbsp;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>  


== Differential Diagnosis<br>  ==
== Differential Diagnosis<br>  ==
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== Examination  ==
== Examination  ==


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add text here related to physical examination and assessment<br>  


== Medical Management <br>  ==
== Medical Management <br>  ==
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add text here <br>  
add text here <br>  
 
== Key Research  ==
== Key Research  ==



Revision as of 21:10, 10 November 2010

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editor - Juliana Doyle, Brachotte Florence, Kirianne Vander Velden

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]

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

Clinically Relevant Anatomy[edit | edit source]

add text here

Epidemiology /Etiology[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

Characteristics/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

Differential Diagnosis
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Other conditions to rule out: fractures, AVN, Legg-Calve Perthes, Osteomyelitis,Septic Arthritis, and groin pull. 1

Diagnostic Procedures[edit | edit source]

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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]

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Examination[edit | edit source]

add text here related to physical examination and assessment

Medical Management
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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

Physical Therapy Management
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Key Research[edit | edit source]

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Resources
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Clinical Bottom Line[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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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.