Slipped Capital Femoral Epiphysis: A Case Report and Comprehensive Review of Current Literature


Rachel Michael*

Citation: Slipped Capital Femoral Epiphysis: A Case Report and Comprehensive Review of Current Literature. American Research Journal of Orthopedics and Traumatology. 2019; 4(1): 1-16.

Copyright This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract:

We present a case report to portray the possible complications of neglected and insitu treated SCFE, and treatment to enable correction of the deformities using total hip arthroplasty. We also conduct a mini review of literature to revisit the epidemiology, pathophysiology, clinical evaluation, and radiographic analysis of slipped capital femoral epiphysis.

This article also highlights the current literature and recommended treatments for slipped capital femoral epiphysis and sequelae associated with this disorder. 


Description:

INTRODUCTION

Slipped capital femoral epiphysis (SCFE) is a condition seen in the adolescent population. Due to its association with obesity, the incidence of SCFE is rising due to the concurrent rise in adolescent obesity in America. However, although obesity is the greatest risk factor, other risk factors for SCFE include endocrinopathies (e.g. hypothyroidism, hypoparathyroidism, vitamin D deficiency, and hormone therapy), femoral retroversion, and history of radiation to the femoral head.

Epidemiologically, males are affected more frequently than females (2:1) and African American adolescents are more commonly affected than those of Caucasian descent (2:1) 1, 2. Adolescents of Polynesian and Latin American descent also have an increased incidence compared to those of Caucasian ancestry 1, 2.

Slipped capital femoral epiphysis occurs in a select age groups (12-15 years old in males and 11-13 years old in females) due to the physiology of the proximal femoral physis in relation the adolescent growth spurt 1, 2, 3, 4. Due to the relation of peak height velocity and growth remaining, SCFE rarely occurs in postmenarcheal females. If SCFE occurs outside of the expected age range, in an underweight patient, or outside of peak height velocity, it is important to assess for other metabolic causes such as endocrinopathies.

Often, SCFE can occur bilaterally. Bilateral slips are noted on initial presentation about 50% of the time 1, 4. If only one hip is affected on initial presentation there is a 17-50% chance of the contralateral hip becoming affected in the first 18 months following in the initial slip. Due to this incidence, close clinical and radiographic follow up is necessary. Additionally, it is sometimes recommended that the contralateral hip be treated prophylactically at the time of initial slip if patient has significant risk factors. Risk factors for contralateral SCFE include open triradiate cartilage and endocrinopathies.

CASE REPORT

History

A 23-year-old male presented with history of left chronic slipped capital femoral epiphysis that was treated at age of 14yrs with in situ screw fixation. The patient states that he has had pain since the occurrence of the SCFE, and has been progressive over time. His pain currently occurs at rest and is worse with activity and ambulation. His pain is sharp and severe and is located over the anterior groin. He also notes limitation in left hip range of motion, especially with extension and internal rotation. Patient has now failed conservative treatment with physical therapy, ambulatory assistive device, activity modification, and use of non-steroidal anti-inflammatory medication as well as narcotics. The patient currently denies any contralateral hip problems. He also denies any numbness, tingling, or weakness. The patient’s medical history is otherwise negative with the exception of his SCFE history. His social history is pertinent for current daily tobacco use.

Physical Exam

On examination the patient is a 23-year-old male who presents with a grotesque left lower extremity deformity along with profound derangement in his gait as well as seated posture. Focused exam of the left lower extremities demonstrated intact skin circumferentially with fixed flexion deformity of 10 degrees, fixed abduction of 10 degrees and external rotation deformity of about 40 degrees approximately. Patient was found to have tenderness over the left greater trochanteric bursa and anterior groin pain with attempted internal rotation. Hip range of motion was then measured and is documented in Table 1. The patient was also noted to have a positive Drehmann sign of the left hip which demonstrated resultant external rotation of the hip with passive flexion.


The patient was found to have full tone and motor strength in flexion and adduction of the bilateral lower extremities. However, it was noted that his left hip abduction was weak compared to the contralateral side, with normal sensations in bilateral lower extremities.

The patient’s stance and gait were also observed and demonstrated varus alignment of the left knee with calcaneo-planovalgus deformity of the left ankle and foot with loss of the plantar medial arch. Patient walks with an antalgic Trendelenburg gait with evident left gluteal muscle wasting and contracture of left hip abductors and external rotators following his flexion, abduction and external rotation deformity as a sequelae of his left hip SCFE. He also walks with an external foot progression bilaterally but with enhanced external foot progression on the left lower extremity as demonstrated in Figure 1.

Radiographs of the patient’s pelvis, left hip, and full-length lower extremities were obtained. Figure 2 illustrates the radiographic images that demonstrate left hip in situ screw fixation with collapse of the left femoral head and coxa magna, along with secondary degenerative changes in the femoral head and acetabulum with an external rotation alignment are also seen. Right hip shows degenerative changes to a lesser extent.