Page 18 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 2
Introduction.
Slipped Capital Femoral Epiphysis (SCFE) is an adolescent disorder of the hip in which the neck of the femur is displaced through the hypertrophic zone of the physis. The proximal femoral neck and shaft translate and rotate anteriorly, superiorly and externally relative to the femoral head, leaving the femoral head in the acetabulum stabilized by the ligamentum teres. The displacement of the femur neck may cause pain and limping at a young age and can cause osteoarthritis at a later stage, possibly initiated by changes in biomechanics and femoro-acetabular impingement (FAI).
The cause of SCFE is probably multifactorial: biomechanical and biochemical factors have been implicated. SCFE is often diagnosed late because most healthcare providers are unfamiliar with this condition. The slip can become progressively severe if not diagnosed early. Healthcare providers should be made more aware of the early signs and symptoms, so that appropriate imaging may lead to earlier recognition and treatment of this motion-limiting disease [104].
SCFE is the most common hip disorder in adolescence, but its incidence is still very low. New literature, however, describes an increase in SCFE incidence, probably due to a general increase in body mass index (BMI). Historically, obese boys were considered to have a higher risk of developing SCFE, but new literature shows girls are becoming increasingly susceptible to it. New insights into pathogenesis provided by modern histological techniques are showing that understanding the roles played by biomechanical and biochemical factors could be important in finding the cause of SCFE. Children in adolescence and with known endocrine disorders are more vulnerable to developing SCFE, reflecting the vulnerability of a weak physis to forces applied to the femoral head.
The treatment is controversial for some subgroups of the disorder. The basic treatment of SCFE to prevent immediate deterioration is to stabilise the slip using a percutaneous screw fixation in the femoral head, but the best method for improving the outcome of secondary deformation of the head is subject to debate. Numerous papers have been published about SCFE. The discussions in the literature focus on the interaction of biomechanical and biochemical causes for SCFE, the changes in its diagnostics and its treatment. This review aims to provide a comprehensive guide of all recent research concerning SCFE. Aspects of SCFE coveredbythisreviewinclude:generalaspects,epidemiology,etiology,pathogenesis, diagnosis, different methods of treatment, complications and prognosis.
16