THE CLINICAL FEATURES AND PATHOPHYSIOLOGY OF SLIPPED CAPITAL FEMORAL EPIPHYSIS
B ) MENTION MEDICAL CONDITIONS ASSOCIATED WITH IT ?
A 5 INTRODUCTION
1 slipped upper femoral epiphysis, SUFE or coxa vara adolescentium is a medical term referring to a fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (epiphysis).
2 Normally, the head of the femur, called the capital, should sit squarely on the femoral neck **
A ) Abnormal movement along the growth plate results in the slip.
B ) The femoral epiphysis remains in the acetabulum (hip socket), while the metaphysis (end of the femur) move in an anterior direction with external rotation.
EPIDEMIOLOGY
1 SCFEs are most common in adolescents 11–15 years of age and affects boys more frequently than girls (male 2:1 female).
2 It is strongly linked to obesity, and weight loss may decrease the risk.
3 Other risk factors include: family history, endocrine disorders, radiation / chemotherapy, and mild trauma.
4 The left hip is more often affected than the right - Over half of cases may have involvement on both sides (bilateral).
PATHOPHYSIOLOGY
1 SCFE is a Salter-Harris type 1 fracture through the proximal femoral physis.
2 Stress around the hip causes a shear force to be applied at the growth plate.
3 While trauma has a role in the manifestation of the fracture, an intrinsic weakness in the physeal cartilage also is present.
4 The almost exclusive incidence of SCFE during the adolescent growth spurt indicates a hormonal role.
5 Obesity is another key predisposing factor in the development of SCFE.
6 The fracture occurs at the hypertrophic zone of the physeal cartilage - Stress on the hip causes the epiphysis to move posteriorly and medially.
7 ** By convention, position and alignment in SCFE is described by referring to the relationship of the proximal fragment (capital femoral epiphysis) to the normal distal fragment (femoral neck).
8 Because the physis has yet to close, the blood supply to the epiphysis still should be derived from the femoral neck; however, this late in childhood, the supply is tenuous and frequently lost after the fracture occurs.
9 Manipulation of the fracture frequently results in osteonecrosis and the acute loss of articular cartilage (chondrolysis) because of the tenuous nature of the blood supply.
CLINICAL FEATURES
1 GROIN PAIN OR THIGH PAIN OR KNEE PAIN ( pain along obturator distribution ) -
A ) pain may occur on both sides of the body (bilaterally), as up to 40 percent of cases involve slippage on both sides.
B ) After a first SCFE, when a second SCFE occurs on the other side, it typically happens within one year after the first SCFE.
C ) About 20 percent of all cases include a SCFE on both sides at the time of presentation.
2 GAIT ABNORMALITIES - waddling gait , antalgic gait , outtoeing gait
3 Decreased ROM - range of motion in hip is restricted in internal rotation , abduction and flexion - HIP IN EXTERNAL ROTATION *
4 Limb length discrepancy - Limb shortening
TYPES
1 Stable SCFE - In stable SCFE, the patient is able to walk or bear weight on the affected hip, either with or without crutches.
A ) Most cases of SCFE are stable slips.
2 Unstable SCFE - This is a more severe slip. The patient cannot walk or bear weight, even with crutches.
A ) Unstable SCFE requires urgent treatment.
B ) Complications associated with SCFE are much more common in patients with unstable slips.
B ) ASSOCIATED MEDICAL CONDITIONS
1 OBESITY
2 HYPOTHYROIDISM
3 HYPERTHYROIDISM - most commonly associated vv imp
4 HYPOPITUITARISM
5 RENAL OSTEODYSTROPHY