Valgus Slipped Capital Femoral Epiphysis

Abstract

Slipped capital femoral epiphysis (SCFE) is a posteromedial displacement of the epiphysis on the metaphysis. Superolateral displacement of the epiphysis, the valgus SCFE, was first described by Müller, although some authors question its existence. We report 4 additional cases and review the literature regarding valgus SCFE. A retrospective review was performed; the child's sex, race, age, weight and height, symptom duration, type of SCFE (stable/unstable), and slip severity were recorded. There were 105 children (67 boys and 38 girls) with 141 idiopathic SCFEs. Four children were noted to have 7 stable valgus SCFEs. Statistically significant differences between the valgus and varus SCFEs were noted for symptom duration and body mass index, and valgus SCFEs tended to be less severe. When combining the data from the literature and the author's institution, there were 22 children with 30 valgus SCFEs at average age of 12.4 +/- 1.8 years; weight, 69.3 +/- 20.6 kg; height, 155.3 +/- 12.4 cm; and body mass index, 27.l +/- 7.1 kg/cm. The demographics of children with valgus SCFE are similar to children with routine SCFE except for sex: 76% of valgus SCFEs occurred in girls. Awareness of valgus SCFEs is necessary for both diagnosis and treatment. In a "valgus" SCFE, Klein line will always be normal, emphasizing the need for lateral radiographs when evaluating all children for SCFE. Single central screw fixation must be approached with caution because the more medial screw entry point places the screw path in immediate proximity to the femoral neurovascular bundle.

Valgus Slipped Capital Femoral Epiphysis in Patient with Hypopituitarism

“…Klein et al used the line along the superior aspect of the femoral neck as an index of SCFE [7]. In valgus SCFE, however, the line will always be normal and this has emphasized the need for lateral radiographs to be performed in all children with hip pain [3]. In our case, the Klein line was normal on anteroposterior radiograph.…”

“…Fewer than 100 cases have been reported to date, and these case reports have not described the specific criteria [2] used in the diagnosis of valgus SCFE. Loder et al estimated the prevalence of valgus slip to be 1.9% by taking into account all the reported cases in literature until 2006 [3]. This indicated approximately 1-2% of all idiopathic SCFE cases were probably due to a valgus slip.…”

Case Reports: Anteroinferior Acetabular Rim Damage Due to Femoroacetabular Impingement

“…Our series is also notable for the inclusion of a patient with valgus SCFE. Although valgus SCFE has been described in the literature [21,32], this is the first description of the site of the intraarticular pathology in a valgus slip. Several series have described FAI occurring after typical SCFE [18,33,39].…”

“…Depending on the degree of the slip, the prominent metaphysis causes an inclusion or an impaction type of injury to the acetabulum [18,28,33]. In comparison, valgus SCFE is much more rare [32] and case series of valgus SCFE have used in situ pinning for treatment, eliminating the ability to directly observe a site of impingement [21,32]. One might expect, however, that a valgus slip would also produce a metaphyseal prominence that might in turn cause FAI and subsequent chondrolabral damage as observed for our patient.…”

Remodelación y deterioro en epifisiólisis de cadera después de la fijación in situ. [Slipped­ capital­ femoral­ epiphysis­ remodeling ­and­ deterioration­ after­ in­ situ ­fixation­]

“…Los deslizamientos en valgo son altamente infrecuentes y ocurren, en general, por traumatismos, radioterapia localizada en la parte proximal del fémur o en pacientes con osteodistrofia renal. [1][2][3][4] La fijación in situ, mediante la colocación de un tornillo canulado de forma percutánea, guiado con intensificador de imágenes, sin ningún intento de reducción previo, es el tratamiento más aceptado, [5][6][7][8][9][10][11] incluso en aquellos deslizamientos >30º, con una deformidad residual en el fémur proximal.…”