Lecture on Slipped Capital Femoral Epiphysis (SCFE)

Introduction

• SCFE: A common hip disorder in adolescents.
• Occurs when the growth plate fractures, causing slippage between the femur neck and the head (epiphysis).

Anatomy of the Femur

• Diaphysis: Long, hard shaft of the bone.
• Metaphysis: Connects diaphysis to the femoral neck.
• Physis (Growth Plate): Cartilaginous area above the femoral neck.
  • Cells divide here for length growth, active during adolescence.
  • Vulnerable to shearing forces; ossifies and fuses with the epiphysis by age 16 in females, 19 in males.
• Perichondrial Ring: Dense connective tissue supporting the growth plate, resisting shearing forces.
• Ball-and-Socket Joint: Femoral head sits in the acetabulum.
  • Stabilized by a joint capsule and ligamentum teres.
• Epiphyseal Blood Vessels: Supply nourishment to femoral head.

Pathophysiology of SCFE

• Weakening of the Perichondrial Ring leads to slippage between the femoral head and neck.
• Actual Displacement: Neck displaces anterolaterally and superiorly.
• Severe displacement can tear blood vessels, causing avascular osteonecrosis.

Risk Factors

• Obesity: Increases pressure on the epiphysis-physis junction.
• Other Risks: Hyperthyroidism, family history.

Symptoms

• Mild Cases: Intermittent pain in groin (may feel like it's from thigh/knee), worsens with activity, causes a limp.
• Severe Cases: Inability to walk, affected leg shorter and externally rotated, difficulty in internal rotation and abduction.

Diagnosis

• Pelvic X-rays: Required in frog-leg lateral view.
• Indicators: Widened joint space, femoral head displacement (posteroinferiorly).

Treatment

• Surgical Stabilization: Screws and pins through growth plate to femoral head.
• Post-surgery Care: Rest, limited weight bearing.
• Prophylactic Fixing: Sometimes applied to contralateral hip.

Recap

• SCFE: Slippage between femur neck and head in adolescents.
• Symptoms include limping, groin pain, and leg deformities in severe cases.
• Diagnosed via x-rays; treated with surgical stabilization.