The Etiology and Management of Slipped Capital Femoral Epiphysis

Abstract

We review insights into slipped capital femoral epiphysis (SCFE) gained during the last decade and updates to current management practices. Anatomic and clinical studies recently demonstrate that the epiphysis rotates around an epiphyseal tubercle during displacement. Clinical endocrinopathies contribute to the pathogenesis of SCFE, and recently the effects of subclinical endocrine derangements have been demonstrated to play a role in SCFE. Patients with positive age-weight or age-height testing are recommended to undergo further endocrine workup due to the high likelihood of atypical SCFE in these patients. In situ pinning with two screws is mainly reserved for unstable or severe slips, while one-screw fixation remains the standard for mild-moderate slips. Contralateral prophylactic pinning is typically considered in those patients with an atypical slip, relative skeletal immaturity, or aberrant radiographic parameters such as posterior epiphyseal tilt or sloping angle. Novel intraoperative epiphyseal perfusion monitoring has provided insight into reducing complications such as avascular necrosis and has shown the benefit of intracapsular hematoma decompression for unstable SCFE. Open surgical management via the modified Dunn procedure should be cautiously considered, as high rates of osteonecrosis have been reported due to the vulnerable blood supply of the proximal femoral head. Key Concepts• The epiphyseal tubercle acts as a prominent stabilizer of the proximal femoral epiphysis and pivot point for a posterior rotation and displacement of the epiphysis during SCFE.• Hyperinsulinism and increased leptin concentrations lead to biochemical alterations of the proximal femoral physis that contribute to physeal failure.• Further endocrine and metabolic workup is needed for patients with a positive age-weight or age-height test due to the high likelihood of atypical SCFE.

Medium-long-term follow-up of slipped capital femoral epiphysis treated with in situ fixation and patient-acceptable symptom state evaluation

“…In our case series, the sample is in line with the literature regarding the mean age and male-female ratio [16,32,33] with a mean age of about 13 years and around 60% males. The percentage of bilateral cases is in line with the reported minimal incidences of bilaterality in the literature (18% vs. 20-25% [34] vs. 18-50% [32]. The timing of presentation recorded, with 83% of cases undergoing surgery more than 3 weeks after symptom onset, is consistent with the literature [31,[35][36][37] and underscores the importance of greater diagnostic accuracy on the part of healthcare personnel.…”

Surgeon Preference for Prophylactic Contralateral Fixation in Slipped Capital Femoral Epiphysis (SCFE) Patients: A Nationwide POSNA Survey Study

“…Endocrinopathies have long been considered risk factors for SCFE, 22 but interestingly, this study demonstrated that surgeons do not consider all endocrinopathies equal. While hypothyroidism may likely be the most commonly studied endocrinopathy in SCFE patients, often, endocrinopathies are grouped as a single risk factor in the orthopedic literature 18 .…”

Management of Atypical Slipped Capital Femoral Epiphysis

“…Other initial treatment options include open reduction using an anterior approach or the modified Dunn technique for surgeons facile in this technique. [59][60][61] Patients presenting with a unilateral slip who are diagnosed with an underlying endocrinopathy or renal disease should undergo bilateral in situ screw fixation given the high risk of contralateral slip progression.…”