Slipped femoral epiphysis

slipped femoral epiphysis with the head displaced downSlipped capital femoral epiphysis is a common hip disorder in children and adolescents characterised by stiffening and pain of the hip joint. It usually occurs in the age of 8 to 15 years. In this condition a bony part of hip slides backwards on the top of the thighbone (the femur). It should be treated earlier so as to avoid complications later in life. Luckily, the complications can be successfully reduced or avoided by the early treatment. Surgery is generally needed to stabilize the hip and stop the condition from becoming worse.

 

Classification: 

Slipped upper femoral epiphysis is classified on the basis of stability of the physis (growth plate) into a stable and an unstable condition. In case of stable slipped upper femoral epiphysis, a patient is able to move about with or without support while in an unstable form a patient cannot move about even with support. Stable slipped upper femoral epiphysis is more common compared to unstable one and offers better prognosis.

 

Risk Factors For Slipped Upper Femoral Epiphysis:

The most common associated risk factors for this condition are 

  • Growth surges
  • Obesity 
  • Certain hormonal disorder for example low level of thyroid hormone, absent or insufficient production of the anterior pituitary hormones or of gonads (ovaries or testes).
  • Growth hormone supplementation

 

Cause:

The cause of this problem is thought to be dependent on several factors, especially hormonal or environmental factors. Hormonal causes are less common compared to environmental. Obesity is the known cause of slipped upper femoral epiphysis. The endocrine/hormonal disorders are considered when a child presents with unusual manifestations, i.e. underweight or below eight years of age or above 15 years.

 

How Does This Condition Develop?

The onset of slipped capital femoral epiphysis occurs at a specific age. During puberty, a number of changes occur in the growing skeleton and these changes lead to the development of slipped capital femoral epiphysis. Children who develop this disorder are usually overweight. This suggests that the main cause of slipped capital femoral epiphysis is the high stresses on the hip joint at a time when the head or ball of the thigh bone (femoral head) is not quite prepared to support these strains. As a result, the head fails at the feeble point; via the neck of the thigh bone (epiphyseal plate) same like an ice cream scoop which may slip off the cone’s top.

 

Signs and Symptoms

The most common symptoms of slipped capital femoral epiphysis are pain and limping. Pain is often vaguely localized to the groin, hip, knee or thigh. History of trauma to the region is uncommon. Patient with a severe slip may be not able to bear weight. The movement of the hip becomes limited and abnormal.

 

Complications:

If this condition is not managed timely, it may lead to

  • Limited hip motion
  • Destruction or loss of articular cartilage of the hip joint
  • Arthritis of the hip joint
  • Severe deformity
  • Differences in lengths of the legs
  • Obstruction of normal blood supply of the hip bone and joint

 

Diagnosis:

X-rays are advised in order to properly and accurately diagnose the slipped upper femoral epiphysis.

X-ray of a case with slipped capital femoral epiphysis

 


Treatment:

Surgery is the mainstay of treatment of slipped upper femoral epiphysis. It prevents capital femoral epiphysis from further slippage. This is achieved by fixing the head in its place with a single screw.

A screw fixing the head to avoid increase slippage

With less slip, the risk of complications in the hip also lowers during the child's life. With mild slips, the surgical procedure is often carried out as an outpatient procedure. However, with severe slips, a more extensive surgery may require.
If surgery is absolutely impossible for some valid reasons, then a hip spica is used to cover the legs, though, it is not an ideal choice and not as successful as surgical procedure.

 

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