Term
| Define slipped capital femoral epiphysis (SCFE) |
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Definition
• a disorder resulting in displacement of the femoral head, usually in an inferior and posterior direction, on
femoral neck
• due to a disturbance of the growth plate of the capital epiphysis
• the femoral head usually stays within acetabulum, but limb becomes externally rotated due to slip
• can only occur before growth plate closure, often during growth spurt |
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Term
| Name the risk factors associated with SCFE |
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Definition
• boys > girls
• AA or Polynesian descent most susceptible
• obese or very tall with weights exceeding the 95th percentile
• delayed skeletal and sexual maturity |
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Term
| Describe the SCFE classification system |
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Definition
1. pre slip
• no displacement but shows changes in the epiphyseal plate
2. grade I
• femoral head is displaced up to 1/3 width of neck
3. grade II
• femoral head is displaced more than 1/3 but less than 1/2 width of neck
4. grade III
• femoral head is displaced more than 1/2 width of neck |
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Term
| Describe the three SCFE onset types |
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Definition
1. chronic
• gradual onset (progression of sx over 3 or more weeks)
• intermittent and gradually increasing pain in the hip, groin, buttock or knee
• limp and decreased ROM
2. acute
• sudden onset (less than 3 week duration)
• abrupt onset of severe pain
• development of limp and decreased ROM
• may not be able to walk on affected leg
• sx may be assoc with an injury or fall
3. acute-on-chronic
• sx gradually building for more than 3 weeks
• trauma causes further slip and an acute exacerbation of sx
• may not be able to walk on affected leg |
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Term
| Describe the presentation and the signs and symptoms of SCFE |
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Definition
• pain in hip, groin, medial thigh and/or knee
• antalgic limp
• Trendelenburg gait
• unable to WB on affected side, especially with acute onset
• limited hip flexion, abduction, and IR
• affected leg is ER in supine and standing
• passive hip flexion is accompanied by ER and abduction
• may have a small LLD |
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Term
| Name the motions which are most limited in SCFE |
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Definition
• hip flexion
• abduction
• internal rotation |
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Term
| Discuss the medical management of SCFE |
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Definition
• goal is stabilization of the growth plate to prevent further displacement, prevent complications such as
AVN and degenerative arthritis and to maintain hip ROM and function
• pre-slip
• NWB ambulation and restricted physical activity
• recommend weight loss and close monitoring
• acute onset
• gentle traction to reduce slip followed by surgical pinning to maintain reduction and prevent
further slippage
• chronic onset
• pin in situ with no reduction (2* accommodation of blood supply to femoral head)
• varus osteotomy may be performed in addition to pinning
• surgery produces best long term results
• prognosis depends on severity of slip and any complications (AVN, migration or penetration of pin
into joint space, DJD later in life) |
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Term
| Describe the physical therapy management of SCFE |
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Definition
• post surgery
• spica cast
• educate parents how to transfer & position child in spica cast
• UE exercises to maintain strength and mobility
• following cast removal focus on AROM and PROM with emphasis on hip flexion, abduction and
IR, MD indicates when post-op strengthening begins
• gait training with LE strength and ROM adequate for ambulation, MD recommends WB status
• no spica cast
• begin ambulation 2-10 days post-op with NWB or TDWB as per MD
• MD indicated when post-op strengthening activities can begin
• may take 1-2 years to regain good pain-free ROM following chronic slip with pinning in situ |
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