Valgus slipped capital femoral epiphysis: presentation, treatment, and clinical outcomes using patient-reported measurements

Abstract

Valgus slipped capital femoral epiphysis (SCFE), is rare. This study describes the diagnosis, treatment and outcome of valgus SCFE in Uruguay. The medical records and radiographs were reviewed in eight consecutive children [mean age 11.9 years (range 9–13; six female)] with valgus SCFE between 1997–2017. In 2018–2019, all patients were reexamined clinically, new radiographs obtained, and patient-reported outcomes completed using the international tool of hip results (iHOT-12). The prevalence of clinical femoroacetabular impingement (FAI), avascular necrosis, and surgical complications were also studied. There were 11 valgus SCFEs in eight patients; two had primary bilateral SCFEs, and one child later developed a valgus SCFE in the contralateral hip. Seven out of eight patients were overweight. All were stable idiopathic SCFEs. The mean femoral head shaft angle on the anteroposterior radiographs for the 11 SCFEs was 145° (range 140–168) and 141° (range 139–145) for the six healthy contralateral hips. Slip severity measured on the Lauenstein projection was mild (<30°) in eight hips and moderate (30°–60°) in three hips. At a mean follow-up of 87 months (range 24–252), there were no cases of avascular necrosis. The mean iHOT12 was 74 (range 13–97). Significant remodeling was detected in both head shaft angle (8°) and alpha angle (10°) in the affected hips. Nine hips (81%) demonstrated clinical signs of FAI. Our study is the first to describe long-term results using both clinical and patient outcome measures (iHOT-12). A majority of patients have residual symptoms, likely associated with FAI.

Management of Atypical Slipped Capital Femoral Epiphysis

“…Gelink et al reported on a small case series of 8 patients with valgus SCFE: 2/8 presented as bilateral slips, 1 patient subsequently developed a contralateral slip, and all of the patients were thought to have idiopathic SCFE. 52 A larger metanalysis found that 31% of valgus SCFE patients (23/74) initially presented as a bilateral SCFE, which is higher than the rate of 18% that has been reported for idiopathic SCFE. 9,53 While valgus slips represent an uncommon subset of SCFE, with about 100 reported cases in the literature, their unique radiographic characteristics make it important for us to identify them.…”

Idiopathic Slipped Capital Femoral Epiphysis: Demographic Differences and Similarities between Stable, Unstable, and Valgus Types

“…In an earlier study, spanning 1998 through 2003 from our institution [ 29 ], four patients with seven valgus SCFEs were described, and all were Black. In a recent study for Uruguay of eight children with valgus SCFEs [ 5 ], seven of the eight were White, and one was Black (Gelink A—personal communication). Segal et al [ 4 ] described patients with valgus SCFE; one was Hispanic, and one was Black.…”

“…Slipped capital femoral epiphysis (SCFE) can be divided into idiopathic and atypical types [ 1 , 2 ], with idiopathic being more common [ 1 ]. Most SCFEs demonstrate a varus deformity, although valgus types do exist [ 3 , 4 , 5 ]. The typical SCFE demonstrates an inferior displacement of the epiphysis relative to the metaphysis on radiographs, thus a varus deformity; however, a few may demonstrate a superior displacement of the epiphysis relative to the metaphysis on radiographs, or a valgus deformity.…”

The morphogenesis of porcine femoral head mammillary processes: A structural mechanism of biomechanical stability

“…Slipped capital femoral epiphysis (SCFE) in humans is characterized clinically as an epiphyseal posteromedial displacement relative to the metaphysis (Khaladkar, Sherawat, et al, 2015; Tayton, 2007). In a small fraction of cases there is a posterolateral displacement of the epiphysis relative to the metaphysis (Gelink, Cúneo, et al, 2021). Torsion has been reported as an etiologic factor in initial slips (Aronson & Tursky, 1996).…”