A 12-year-old child with a history of obesity presented to the orthopaedic clinic limping and experiencing dull hip discomfort for the past two weeks. After he slipped and fell at school, the symptoms started to appear. The patient’s body mass index was higher than the 95th percentile for his age during the physical examination. The right hip’s active and passive ranges of motion were constrained by pain. Radiographs of the pelvis revealed blurring of the right metaphyseal growth-plate junction (Panel B, asterisk; anteroposterior view) and posterior displacement of the right femoral epiphysis, which has been likened to an ice cream scoop falling off a cone (Panel A, asterisk; frog-leg lateral view). A slipping capital femoral epiphysis diagnosis was made.
This is a common hip disorder in teenagers. It happens when the proximal femur shifts anterolaterally and superiorly, giving the epiphysis the illusion of shifting posteriorly and inferiorly. Obesity is a risk factor for the illness, although prior trauma is not often a factor, as was the case in this instance. Treatment included right hip in situ fixation. The patient’s symptoms were gone at a 9-month follow-up appointment. A second radiograph of the pelvis revealed that the right hip had fused without lateral slippage.
Slipped capital femoral epiphysis in children
Children are more susceptible to slipped capital femoral epiphysis (SCFE). In SCFE, the femoral head—the ball of the thighbone—slips off the thighbone’s neck. SCFE is frequently compared to an ice cream scoop that falls off the top of a cone. Around 2 out of 5 instances include both hips. However, the cause of the condition is not known and often occurs because of an injury, for example, a fall. But it typically takes happens gradually over time. Following the onset of puberty, SCFE typically develops during brief periods of rapid growth.
Surgery is used to treat SCFE and prevent the head of the femur from sliding any further. It’s crucial to get a diagnosis as soon as possible in order to get the best treatment outcomes. Without prompt diagnosis and appropriate care, SCFE can result in potentially dangerous consequences, such as the femoral head degenerating quickly or severe hip arthritis.
Anatomy
To understand the health and status of the patient, it is important to understand the anatomy of the disease. The hip is described as a ball and socket joint. The acetabulum which is a piece of the large pelvis bone, creates the socket. Whereas the upper end of the femur is known as the femoral head.
The femur does not grow from the centre outward like the other long bones in the body. Instead, growth takes place around the growth plate (physis), a region of growing cartilage, near each end of the bone.
Between the bone’s widened part (metaphysis) and end of the bone (epiphysis), there are growth plates. The femoral head develops from the epiphysis, which is located near the top of the femur.
SCFE is the most common hip disease in adolescents. In SCFE, the growth plate, a weaker region of undeveloped bone, allows the epiphysis, or head of the femur, to slip down and backward off the bone’s neck.
SCFE typically appears immediately after puberty begins, during times of fast growth. For boys, this most frequently happens between the ages of 12 and 16, and for girls, between the ages of 10 and 14.
Sometimes, following a small accident or injury, SCFE strikes unexpectedly. However, more frequently than not, the illness appears gradually over a period of weeks or months with no prior history of injury. Similarly, although the cause of the disease is not known, risk factor may include excess weight or obesity. Other causes may include a family history of SCFE, an endocrine or metabolic disorder. This is more common for patients who are younger or older than the typical age range.
Source: NEJM
