A systematic review of the literature recommends on the basis of level of evidence that the best treatment for a stable SCFE is single screw in situ fixation and for unstable SCFEs urgent gentle reduction, decompression, and internal fixation. Level of evidence: Level IV, systematic review of level IV studies.
Is there evidence for the treatment of Slipped capital femoral epiphysis?
A systematic review of the literature recommends on the basis of level of evidence that the best treatment for a stable SCFE is single screw in situ fixation and for unstable SCFEs urgent gentle reduction, decompression, and internal fixation. Level of evidence: Level IV, systematic review of level IV studies. Publication types
What is the epiphysis of the femur?
A systematic review of the literature recommends on the basis of level of evidence that the best treatment for a stable SCFE is single screw in situ fixation and for unstable SCFEs urgent gentle reduction, decompression, and internal fixation. Level of Evidence : Level IV, systematic review of level IV studies.
What is the modified Dunn procedure for slipped capital femoral epiphysis?
Sep 01, 2012 · A systematic review of the literature recommends on the basis of level of evidence that the best treatment for a stable SCFE is single screw in situ fixation and for unstable SCFEs urgent gentle reduction, decompression, and internal fixation. Level of evidence Level IV, systematic review of level IV studies.
What is a mild epiphysis slip?
A systematic review of the literature recommends on the basis of level of evidence that the best treatment for a stable SCFE is single screw in situ fixation and for unstable SCFEs urgent gentle...
What is the best treatment for slipped capital femoral epiphysis?
What is the best view to diagnose SCFE?
How can slipped capital femoral epiphysis be prevented?
Which of the following is the most typical presenting symptom of slipped capital femoral epiphysis?
How do you measure a SCFE slip angle?
What is the modified Dunn procedure?
What is the cause of slipped capital femoral epiphysis?
What happens if SCFE is not treated?
Is slipped capital femoral epiphysis an emergency?
What is a possible complication of capital femoral epiphysis?
What does a slipped capital femoral epiphysis feel like?
What is a slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting adolescents with an estimated incidence of between 1 to 24.6 per 100,000 children between the ages of 8 and 15.1,2The relative frequency to Caucasians is highest with Polynesians (5.6:1), Blacks (3.9:1) and Hispanics (2.5:1).1Delayed diagnosis is believed to be the most important factor associated with poor outcomes.3,4Less severe and stable slips have been successfully managed with in situpinning to protect against further displacement. The treatment of high grade unstable slips is more controversial with a recent trend toward surgical hip dislocation and reduction of the slip normally with a corrective femoral osteotomy.5The residual healed deformity can lead to femoro-acetabular impingement (FAI) and eventual degenerative osteoarthritis.6,7
What level of studies are there for SCFE?
Most of the studies were level 4 (n=55) followed by level 3 (n=12) and level 2 (n=1) evidence as displayed in Table 5.
How are CEBM studies sorted?
The first two authors sorted the studies based on abstracts from the electronic search. Each author sorted through the databases, which was then validated by the other author. The included studies were then sorted into CEBM study types (Table 1) and into treatment type. If a study involved multiple treatment types it was placed in category that the majority of the study involved. If the abstract did not provide enough information for classification then the full text was obtained (n=128). Once the decision was made to include the manuscript for further analysis then authorship and journal of publication were assessed. Any disagreements between reviewers were resolved by discussion. The senior author was consulted if a consensus could not be reached at any stage of the analysis and categorization.
How long has there been no change in the mean level of evidence published?
Over the 23.5-year time period examined, there has been no change in the mean level of evidence published. The majority of studies from 1991 to 2003 were level 4 and 5 case series/reports (91%) and this remained relatively unchanged by 2014 (87.6%). The geographical location of the studies is given in Table 4. North American journals were noted to have published 58.9% of the available literature within the reference period, 23.1% of publications originated from Europe and 11.5% from Asia with the remaining publications equally distributed across Africa, Australia and the Middle East.
What is EBM in medical terms?
The concept of evidence-based medicine (EBM) was first described in the 1980’s as the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.8The EBM grading system can be obtained in the Oxford Centre for Evidence-Based Medicine (CEBM).9A study gave a level from 1 to 5 on the basis of its design and as 1 of 4 different types on the basis of its content. Level 1 is the highest level of evidence, which includes high quality, randomized controlled trials (RCTs); and level 5, is the lowest level of evidence, and includes expert opinions. This system is accepted and used by most of the medical world including most orthopedic journals.
What is a slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is a common hip disorder in children and adolescents, and it consists in posteroinferior migration of the epiphysis in metaphysis through the physis in proximal femur. The current incidence of SCFE ranges from 0.33 in 100,000 to 24.58 in 100,000 children 8–15 years of age, depending upon sex and ethnicity.
When is SCFE radiography needed?
Radiography is needed when patients 8–15 years of age complain of new-onset limping and lower-limb pain. When SCFE is suspected, radiography should include anteroposterior and frog-leg views of both hips. In unstable SCFE, such imaging should be compared to the unaffected side. Several radiographic signs are suggestive of SCFE, such as widening of the physis, relative decreased height of the epiphysis, loss of intersection of the epiphysis by a lateral cortical line along the femoral neck (Klein’s line) and double density detected at the metaphysis (Steel sign, which is caused by posterior slip of the epiphysis).15–17
What are the antecedents of SCFE?
Antecedents include greater retroversion of the femoral neck or a coxa profunda5related to major weakness of the growth plate during the period of rapid growth.6 Gebhart et al examined the differences in two common anatomic measurements – pelvic incidence (PI) and acetabular retro-version – and their associations with post-SCFE deformity. They claimed that in a patient with a small PI, the pelvis will often tilt forward to maintain normal lumbar lordosis and balance sagittal alignment of the spine. Such anterior tilt would load the anterior aspect of the hip joint and deliver the stress across the physis of the proximal femur. This increased stress, along with other mechanical insults, such as obesity, physeal sloping angle, femoral retroversion, and size of the epiphyseal tubercle, could potentially result in the development of an SCFE. Their study demonstrated that specimens with SCFE deformity have a smaller PI than a large cohort of normal control specimens. On the contrary, they did not find significant differences between acetabular versions of specimens with and without SCFE deformity. The unaffected acetabulum of SCFE specimens was not more retroverted than the affected side.7
How long does SCFE last?
Chronic SCFE represents the major part of the disease (around 85%): symptoms are present for >3 weeks, with remission and relapse.
What causes a SCFE?
On the other hand, metabolic causes implicated in SCFE are obesity,10some endocrinological diseases, such as hypothyroidism and kidney failure, and treatment with growth hormone. 5As previously reported, the onset of SCFE usually occurs during the period of maximum growth, but the age of onset is continuously changing, as there has recently been a tendency for this period to occur earlier.11Most case series have reported bilateral involvement in as many as 63% of patients,2underlining the importance of metabolic factors. Kohno et al found that ~70% of contralateral hips in unilateral SCFE patients had a subclinical posterior inclination of the capital femoral epiphysis, indicating the possibility of bilateral involvement. The contralateral posterior sloping angle was a reliable predictor of a contralateral slip, and an angle of 19° was the cutoff value for developing SCFE.12
What is the role of MRI in hip surgery?
Magnetic resonance imaging (MRI), computed tomography, and bone scintigraphy have a significant role in evaluation of the disease. They can be used at the diagnostic stage, but they are even more useful in appraisal of severity, in surgical planning, and in assessment of prognosis. MRI can detect avascular necrosis (AVN), chondrolabral defects, and periarticular and bone edema. Computed tomography provides a three-dimensional view of the hip, estimating with accuracy the entity of the dislocation. Bone scintigraphy is also a precious aid for diagnosis, with 100% negative predictive value for SCFE.20
Is intracapsular hematoma always present?
They also noticed that an intracapsular hematoma was not always present, but still not crucial for classification . Integrity of the retinaculum and of its attachment on the epiphysis was evaluated empirically at the time of surgical dislocation and presentation of the femoral head–neck junction.25. Treatment.
What is a slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) a disorder of adolescents in which the growth plate is damaged and the femoral head moves (“slips”) with respect to the rest of the femur. The head of the femur stays in the cup of the hip joint while the rest of the femur is shifted.
What causes the femoral head to slip off the neck of the femur?
These factors lead to weakening of the growth plate (also called the “physis”) which then causes the femoral head (ball of the femur) to slip off the neck of the femur. Obesity is a major risk factor. Certain endocrine disorders are risk factors for SCFE, such as hypothyroidism and osteodystrophy.
What are the complications of SCFE?
The first is “ osteonecrosis .” “Osteo” means bone and “necrosis” means death . In osteonecrosis , the blood supply to the femoral head is damaged and the bone dies. This can lead to degenerative joint disease ( osteoarthritis ). The other complication is called “chondrolysis”. “Chondro” means cartilage and “lysis” means cutting apart. In this complication, the joint cartilage is damaged and leads to a painful and stiff joint.
What is the result of SCFE?
The first is “ osteonecrosis .” “Osteo” means bone and “necrosis” means death. In osteonecrosis, the blood supply to the femoral head is damaged and the bone dies.
What is the femur?
The femur is the long bone of the thigh. The end of the femur that connects with the hip consists of a “ball” (called the femoral head). The ball fits inside of a “cup” that is made up of the pelvic bones and is known as the acetabulum.
How can adolescents reduce the risk of degenerative joint disease?
Even without complications, there is still an increased risk of degenerative joint disease. Losing weight, however, is a major way in which an adolescent can reduce the risk of the later development of degenerative joint disease.
How long does it take for a slip to heal?
In extreme cases, it is important to perform surgery on the day of diagnosis. However, most slips are stable and can wait 3-14 days for operative treatment. During the time between diagnosis and surgery, it is important to have the child rest and avoid putting weight on the affected leg.
What is a slipped capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents , occurring in 10.8 per 100,000 children. SCFE usually occurs in those eight to 15 years of age and is one of the most commonly missed diagnoses in children.
What are the signs of slipped capital epiphysis?
Anteroposterior radiography of left-sided slipped capital femoral epiphysis. Radiologic signs include: (A) Steel sign—on anteroposterior radiography, double density is found at the metaphysis (caused by the posterior lip of the epiphysis being superimposed on the metaphysis); (B) widening of the growth plate (physis) compared with the uninvolved side; (C) decreased epiphyseal height compared with the uninvolved side; (D) Klein's line—on anteroposterior radiography, a line drawn along the superior edge of the femoral neck should normally cross the epiphysis; the epiphysis will fall below this line in slipped capital femoral epiphysis; and (E) lesser trochanter prominence, which is caused by external rotation of the femur.
What is SCFE rehabilitation?
Rehabilitation for SCFE includes a five-phase protocol that focuses on protection, pain-free ambulation, neuromuscular control, strengthening, and performance enhancement.
How common is SCFE?
The prevalence of SCFE is 10.8 cases per 100,000 childern. 2, 13 It is typically more common in boys than girls. However, the prevalence is changing because of increasing body weight, which may also account for increased incidence in blacks and Pacific Islanders. 13 The average age at diagnosis is 13.5 years for boys and 12 years for girls. 13 SCFE presents bilaterally in 18% to 50% of patients. 15 – 17 Some slips present sequentially, often occurring within 18 months of each other. 11 There is a seasonal variation in the rate of SCFE in the northern United States, with increased rates in late summer and fall in patients who live north of 40 degrees latitude. 18, 19 This may be caused by increased physical activity in the summer or from impaired vitamin D synthesis.
What is SCFE associated with?
It is associated with obesity, growth spurts, and (occasionally) endocrine abnormalities such as hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism. Patients with SCFE usually present with limping and poorly localized pain in the hip, groin, thigh, or knee.
What is the obligatory external rotation of the hip?
Obligatory external rotation of the hip (Drehmann sign ). While supine, the patient is asked to flex the involved hip. Flexion with external rotation occurs when slipped capital femoral epiphysis is present.
What is the most telling sign of a patient with a severe slip?
On physical examination, the patient may have an antalgic gait or may be unable to bear weight with a severe slip. Limited internal rotation of the hip is the most telling sign. 9 Obligatory external rotation (Drehmann sign) is noted in the involved hip of patients with SCFE when the hip is passively flexed to 90 degrees 1, 5, 9 ( Figure 2 3). Unless the patient has bilateral SCFE, it is helpful to compare range of motion with the uninvolved hip.
What is the goal of treatment for a displaced femoral head?
The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery.
Where does the femur grow?
Instead, growth occurs at each end of the bone around an area of developing cartilage called the growth plate (physis).
Why is SCFE more common in boys than girls?
The cause of SCFE is not known. The condition is more likely to occur during a growth spurt and is more common in boys than girls. Risk factors that make someone more likely to develop the condition include: Excessive weight or obesity—most patients are above the 95th percentile for weight. Family history of SCFE.
What are the complications of SCFE?
Complications following SCFE include avascular necrosis (degeneration of the femoral head), chondrolysis (rapid onset of painful arthritis), and impingement.
What is the most common hip disorder in adolescents?
SCFE is the most common hip disorder in adolescents. In SCFE, the epiphysis, or head of the femur (thighbone), slips down and backwards off the neck of the bone at the growth plate, the weaker area of bone that has not yet developed.
What are the risk factors for SCFE?
Risk factors that make someone more likely to develop the condition include: 1 Excessive weight or obesity—most patients are above the 95th percentile for weight 2 Family history of SCFE 3 An endocrine or metabolic disorder, such as hyperthyroidism—this is more likely to be a factor for patients who are older or younger than the typical age range for SCFE (10 to 16 years of age)
How to treat SCFE?
Procedures used to treat SCFE include: In situ fixation. This is the procedure used most often for patients with stable or mild SCFE. The doctor makes a small incision near the hip, then inserts a metal screw across the growth plate to maintain the position of the femoral head and prevent any further slippage.