Slipped capital femoral epiphysis is a hip condition that occurs in teens and pre-teens that are still growing. For reasons that are not well understood, the ball at the head of the femur slips off the neck of the bone in a backwards direction. This causes pain, stiffness, and instability in the affected hip. The condition usually develops progressively over time and is more typical in boys than girls.
Types of Slipped Capital Femoral Epiphysis include:
- Stable SCFE:
In stable SCFE, the patient is able to walk or bear weight on the affected hip, either with or without crutches. Most cases of SCFE are stable slips.
- Unstable SCFE:
This is a more severe slip. The patient cannot walk or bear weight, even with crutches. Unstable SCFE requires urgent treatment. Complications associated with SCFE are much more common in patients with unstable slips.
Treatment for Slipped Capital Femoral Epiphysis in India
The short-term goal of surgery is to prevent further progression of the slip and the longer-term goal is to prevent femoroacetabular impingement (FAI); residual abnormal morphology of the proximal femur is believed to be the reason for labral and ligament damage prompting osteoarthritis of the hip.
Single in situ centre-to-centre screw fixation across the growth plate (pinning in situ) under fluoroscopic control is accepted as the most effective treatment for a stable slip:
- It is minimally invasive requiring only a small incision on the thigh.
- It is the most common treatment in all situations, stable and unstable, regardless of degree of deformity.
- In one series, excellent to good results were shown in 95% of mild slips, 91% of moderate slips and 86% of severe slips.
- Arthrogram-assisted pinning may improve screw placement, particularly when fluoroscopic imaging is difficult due to weight.
- Open reduction
- Most involve an osteotomy of the femoral neck, which has previously been reserved for treatment of severe deformities after the patient has stopped growing.
- Sometimes includes a surgical hip dislocation to make a stretched out retinacular fold to secure the blood supply to the femoral neck.
- Routine use of open reduction is not recommended and it remains under evaluation.
- It may reduce the rate of avascular necrosis (AVN) in unstable SCFE.
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