Slipped Capital Femoral Epiphysis
aka Slipped Upper Femoral Epiphysis
Causes:
Obesity
Hx
9-16yo
M>F
Limp
Groin/hip pain
Medial thigh pain
Knee pain
dull while mobilise (stable)
sharp, sudden (unstable)
Ex
out toeing
limited internal rotation or globally in the hip
positive trendelenberg (Pelvis drops)
Straight leg raise fail
Ix
Xray pelvis - lateral frog
Types
1) stable (Mild - Mod)
2) unstable (severe or chronic)
Grades
Rx
NBM > SCH
Percutaneous pin bilaterally (prophylactic for other hip) and NWB for 6/52 (Walking aid)
OR Osteotomy and 6/52 (walking aid) to 12m NWB (wheelchair) if poor blood supply
DVT prophylaxis
Complications
AVN > hip replacement
OA
Reduced ROM
Chondrolysis
Protrusion of implant
Causes:
Obesity
Hx
9-16yo
M>F
Limp
Groin/hip pain
Medial thigh pain
Knee pain
dull while mobilise (stable)
sharp, sudden (unstable)
Ex
out toeing
limited internal rotation or globally in the hip
positive trendelenberg (Pelvis drops)
Straight leg raise fail
Ix
Xray pelvis - lateral frog
Types
1) stable (Mild - Mod)
2) unstable (severe or chronic)
Grades
- Mild <1/3 diameter of the femoral neck
- Moderate
- Severe >1/2
Rx
NBM > SCH
Percutaneous pin bilaterally (prophylactic for other hip) and NWB for 6/52 (Walking aid)
OR Osteotomy and 6/52 (walking aid) to 12m NWB (wheelchair) if poor blood supply
DVT prophylaxis
Complications
AVN > hip replacement
OA
Reduced ROM
Chondrolysis
Protrusion of implant