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Slipped Capital Femoral Epiphysis
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Slipped capital femoral epiphysis (SCFE, pronounced "skiffie")
        • Definitions

          • Salter-Harris I fracture of subcapital femoral physis due to chronic stress of weight bearing
            • SCFE term not used for acute trauma
          • Capital femoral epiphysis = femoral head
          • Subcapital physis = proximal femoral growth plate

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Boyle MJ et al: The alpha angle as a predictor of contralateral slipped capital femoral epiphysis. J Child Orthop. 10(3):201-7, 2016
                                    2. Roaten J et al: Complications related to the treatment of slipped capital femoral epiphysis. Orthop Clin North Am. 47(2):405-13, 2016
                                    3. Thawrani DP et al: Current practice in the management of slipped capital femoral epiphysis. J Pediatr Orthop. 36(3):27-37, 2016
                                    4. Whyte N et al: Slipped capital femoral epiphysis in atypical patients. Pediatr Ann. 45(4):e128-34, 2016
                                    5. Clement ND et al: Slipped capital femoral epiphysis: is it worth the risk and cost not to offer prophylactic fixation of the contralateral hip? Bone Joint J. 97-B(10):1428-34, 2015
                                    6. Hosseinzadeh P et al: Delay in the diagnosis of stable slipped capital femoral epiphysis. J Pediatr Orthop. ePub, 2015
                                    7. Nectoux E et al: Evolution of slipped capital femoral epiphysis after in situ screw fixation at a mean 11 years' follow-up: a 222 case series. Orthop Traumatol Surg Res. 101(1):51-4, 2015
                                    8. Novais EN et al: Modified Dunn procedure is superior to in situ pinning for short-term clinical and radiographic improvement in severe stable SCFE. Clin Orthop Relat Res. 473(6):2108-17, 2015
                                    9. Abu Amara S et al: Surgery for slipped capital femoral epiphysis in adolescents. Orthop Traumatol Surg Res. 100(1 Suppl):S157-67, 2014
                                    10. Georgiadis AG et al: Slipped capital femoral epiphysis: how to evaluate with a review and update of treatment. Pediatr Clin North Am. 61(6):1119-35, 2014
                                    11. Peck K et al: Slipped capital femoral epiphysis: what's new? Orthop Clin North Am. 45(1):77-86, 2014
                                    12. Wenger DR et al: Acute, unstable, slipped capital femoral epiphysis: is there a role for in situ fixation? J Pediatr Orthop. 34 Suppl 1:S11-7, 2014
                                    13. Monazzam S et al: Multiplanar CT assessment of femoral head displacement in slipped capital femoral epiphysis. Pediatr Radiol. 43(12):1599-605, 2013
                                    14. Westhoff B et al: Radiological outcome and gait function of SCFE patients after growth arrest. J Child Orthop. 7(6):507-12, 2013
                                    15. Witbreuk M et al: Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: a systematic review of the literature. J Child Orthop. 7(3):213-23, 2013
                                    16. Novais EN et al: Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. Clin Orthop Relat Res. 470(12):3432-8, 2012
                                    17. Venkatadass K et al: Valgus slipped capital femoral epiphysis: report of two cases and a comprehensive review of literature. J Pediatr Orthop B. 20(5):291-4, 2011
                                    18. Zilkens C et al: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC), after slipped capital femoral epiphysis. Eur J Radiol. 79(3):400-6, 2011
                                    19. Miese FR et al: MRI morphometry, cartilage damage and impaired function in the follow-up after slipped capital femoral epiphysis. Skeletal Radiol. 39(6):533-41, 2010
                                    20. Sankar WN et al: The unstable slipped capital femoral epiphysis: risk factors for osteonecrosis. J Pediatr Orthop. 30(6):544-8, 2010
                                    21. Shank CF et al: Valgus slipped capital femoral epiphysis: prevalence, presentation, and treatment options. J Pediatr Orthop. 30(2):140-6, 2010
                                    22. Green DW et al: A modification of Klein's Line to improve sensitivity of the anterior-posterior radiograph in slipped capital femoral epiphysis. J Pediatr Orthop. 29(5):449-53, 2009
                                    23. Tins B et al: The role of pre-treatment MRI in established cases of slipped capital femoral epiphysis. Eur J Radiol. 70(3):570-8, 2009
                                    24. Sasaki M et al: Anterior slip of the capital femoral epiphysis. A case report. J Bone Joint Surg Am. 89(4):855-8, 2007
                                    25. Billing L et al: Reliable X-ray diagnosis of slipped capital femoral epiphysis by combining the conventional and a new simplified geometrical method. Pediatr Radiol. 32(6):423-30, 2002
                                    26. Futami T et al: Sequential magnetic resonance imaging in slipped capital femoral epiphysis: assessment of preslip in the contralateral hip. J Pediatr Orthop B. 10(4):298-303, 2001
                                    27. Kennedy JG et al: Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis. J Pediatr Orthop. 21(2):189-93, 2001
                                    28. Hansson G et al: Long-term results after nailing in situ of slipped upper femoral epiphysis. A 30-year follow-up of 59 hips. J Bone Joint Surg Br. 80(1):70-7, 1998
                                    29. Boles CA et al: Slipped capital femoral epiphysis. Radiographics. 17(4):809-23, 1997
                                    30. Lubicky JP: Chondrolysis and avascular necrosis: complications of slipped capital femoral epiphysis. J Pediatr Orthop B. 5(3):162-7, 1996
                                    31. Towbin R et al: Neonatal traumatic proximal femoral epiphysiolysis. Pediatrics. 63(3):456-9, 1979
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Slipped capital femoral epiphysis (SCFE, pronounced "skiffie")
                                          • Definitions

                                            • Salter-Harris I fracture of subcapital femoral physis due to chronic stress of weight bearing
                                              • SCFE term not used for acute trauma
                                            • Capital femoral epiphysis = femoral head
                                            • Subcapital physis = proximal femoral growth plate

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Nuclear Medicine Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Boyle MJ et al: The alpha angle as a predictor of contralateral slipped capital femoral epiphysis. J Child Orthop. 10(3):201-7, 2016
                                                                      2. Roaten J et al: Complications related to the treatment of slipped capital femoral epiphysis. Orthop Clin North Am. 47(2):405-13, 2016
                                                                      3. Thawrani DP et al: Current practice in the management of slipped capital femoral epiphysis. J Pediatr Orthop. 36(3):27-37, 2016
                                                                      4. Whyte N et al: Slipped capital femoral epiphysis in atypical patients. Pediatr Ann. 45(4):e128-34, 2016
                                                                      5. Clement ND et al: Slipped capital femoral epiphysis: is it worth the risk and cost not to offer prophylactic fixation of the contralateral hip? Bone Joint J. 97-B(10):1428-34, 2015
                                                                      6. Hosseinzadeh P et al: Delay in the diagnosis of stable slipped capital femoral epiphysis. J Pediatr Orthop. ePub, 2015
                                                                      7. Nectoux E et al: Evolution of slipped capital femoral epiphysis after in situ screw fixation at a mean 11 years' follow-up: a 222 case series. Orthop Traumatol Surg Res. 101(1):51-4, 2015
                                                                      8. Novais EN et al: Modified Dunn procedure is superior to in situ pinning for short-term clinical and radiographic improvement in severe stable SCFE. Clin Orthop Relat Res. 473(6):2108-17, 2015
                                                                      9. Abu Amara S et al: Surgery for slipped capital femoral epiphysis in adolescents. Orthop Traumatol Surg Res. 100(1 Suppl):S157-67, 2014
                                                                      10. Georgiadis AG et al: Slipped capital femoral epiphysis: how to evaluate with a review and update of treatment. Pediatr Clin North Am. 61(6):1119-35, 2014
                                                                      11. Peck K et al: Slipped capital femoral epiphysis: what's new? Orthop Clin North Am. 45(1):77-86, 2014
                                                                      12. Wenger DR et al: Acute, unstable, slipped capital femoral epiphysis: is there a role for in situ fixation? J Pediatr Orthop. 34 Suppl 1:S11-7, 2014
                                                                      13. Monazzam S et al: Multiplanar CT assessment of femoral head displacement in slipped capital femoral epiphysis. Pediatr Radiol. 43(12):1599-605, 2013
                                                                      14. Westhoff B et al: Radiological outcome and gait function of SCFE patients after growth arrest. J Child Orthop. 7(6):507-12, 2013
                                                                      15. Witbreuk M et al: Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: a systematic review of the literature. J Child Orthop. 7(3):213-23, 2013
                                                                      16. Novais EN et al: Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. Clin Orthop Relat Res. 470(12):3432-8, 2012
                                                                      17. Venkatadass K et al: Valgus slipped capital femoral epiphysis: report of two cases and a comprehensive review of literature. J Pediatr Orthop B. 20(5):291-4, 2011
                                                                      18. Zilkens C et al: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC), after slipped capital femoral epiphysis. Eur J Radiol. 79(3):400-6, 2011
                                                                      19. Miese FR et al: MRI morphometry, cartilage damage and impaired function in the follow-up after slipped capital femoral epiphysis. Skeletal Radiol. 39(6):533-41, 2010
                                                                      20. Sankar WN et al: The unstable slipped capital femoral epiphysis: risk factors for osteonecrosis. J Pediatr Orthop. 30(6):544-8, 2010
                                                                      21. Shank CF et al: Valgus slipped capital femoral epiphysis: prevalence, presentation, and treatment options. J Pediatr Orthop. 30(2):140-6, 2010
                                                                      22. Green DW et al: A modification of Klein's Line to improve sensitivity of the anterior-posterior radiograph in slipped capital femoral epiphysis. J Pediatr Orthop. 29(5):449-53, 2009
                                                                      23. Tins B et al: The role of pre-treatment MRI in established cases of slipped capital femoral epiphysis. Eur J Radiol. 70(3):570-8, 2009
                                                                      24. Sasaki M et al: Anterior slip of the capital femoral epiphysis. A case report. J Bone Joint Surg Am. 89(4):855-8, 2007
                                                                      25. Billing L et al: Reliable X-ray diagnosis of slipped capital femoral epiphysis by combining the conventional and a new simplified geometrical method. Pediatr Radiol. 32(6):423-30, 2002
                                                                      26. Futami T et al: Sequential magnetic resonance imaging in slipped capital femoral epiphysis: assessment of preslip in the contralateral hip. J Pediatr Orthop B. 10(4):298-303, 2001
                                                                      27. Kennedy JG et al: Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis. J Pediatr Orthop. 21(2):189-93, 2001
                                                                      28. Hansson G et al: Long-term results after nailing in situ of slipped upper femoral epiphysis. A 30-year follow-up of 59 hips. J Bone Joint Surg Br. 80(1):70-7, 1998
                                                                      29. Boles CA et al: Slipped capital femoral epiphysis. Radiographics. 17(4):809-23, 1997
                                                                      30. Lubicky JP: Chondrolysis and avascular necrosis: complications of slipped capital femoral epiphysis. J Pediatr Orthop B. 5(3):162-7, 1996
                                                                      31. Towbin R et al: Neonatal traumatic proximal femoral epiphysiolysis. Pediatrics. 63(3):456-9, 1979