Slipped Capital Femoral Epiphysis: Preventing and Managing Complications.

Abstract

In nonmedical English parlance, a “slip” is a relatively benign event. But the term “slipped” in orthopaedics often describes a potentially serious condition, as in a slipped capital femoral epiphysis (SCFE). This usually backward slippage of the femur’s proximal epiphysis through the hypertrophic zone of the growth plate is one of the most common causes of hip pain in adolescents. Early detection and treatment of SCFE (typically with in situ screw fixation) is crucial because complications of the untreated condition are serious; they include osteonecrosis, chondrolysis, degenerative joint disease, chronic pain, and gait abnormalities. Bone destruction from SCFE is largely the result of blood-supply restrictions to the epiphysis, with subsequent articular cartilage damage occurring because of femoral head deformity. A case in the February 26 edition of JBJS Case Connector suggests that optimal treatment of osteonecrosis associated with SCFE may include hinged distraction after fixation. Madan and Maheshwari report on a ten-year-old girl who twisted her right leg while playing rugby. She continued to be weight-bearing on the leg for a few days, but then presented unable to bear weight. Radiographs revealed a severe SCFE, and she underwent an in situ single screw fixation within twenty-four hours of presentation, approximately one week after the onset of the initial symptoms. A postoperative radiograph revealed that the posteriorly positioned screw had exited the femoral neck and had penetrated the femoral head, putting the posterior retinacular vessels at risk. The authors first saw the patient at six weeks postinjury; three-phase computed tomography of both hips showed photopenia around the right femoral head …