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Slipped capital femoral epiphysis (SCFE) is a common hip pathology occurring in pediatrics and adolescents, and its management is well documented in the literature regardless of its severity. In patients presenting with unilateral SCFE, the incidence of subsequent contralateral slip (SCS) is variable among studies, and the issue of contralateral hip prophylactic fixation (CHPF) becomes a concern. The fundamental rationale behind performing CHPF is to avoid the subsequent contralateral slip, which consequently lowers the risk of femoral head avascular necrosis and chondrolysis. However, prophylactic fixation carries the risk of altering proximal femoral growth, peri-implant fractures, and requiring secondary surgery for hardware removal. The current review was formulated based on the literature published in the last decade and aimed to evaluate the incidence of SCS and indications for CHPF. Apart from institutions' protocol or individual surgeons' preferences, various variables were suggested to justify CHPF, including patient-related variables such as the presence of endocrinopathy, those younger than 13 years old (10–13), and patients with mOBAS ≤ 20. Radiological parameters, posterior slip angle ≥ 14.5°, positive crossover sign, posterior epiphyseal tilt of ≥ 10°, alpha angle of ≥ 49°, and a Probability analysis of sequential SCFE (PASS score) of ≥ 3. However, there is still a controversy in the literature regarding CHPF performance and which parameter is highly dependable for predicting the SCS. The controversy extends to the effect and efficacy of various fixation hardware and whether keeping patients under observation is less effective than CHPF. Furthermore, well-designed randomized controlled trials are lacking, and their performance is warranted to establish clear indications for performing CHPF and to clarify its safety, possible consequences, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background: Slipped Capital Femoral Epiphysis (SCFE) is a prevalent pediatric orthopedic condition. Treatment options range from in situ pinning to various osteotomies, with the Modified Dunn procedure gaining significant attention over the past two decades. However, the suitability of this procedure for different SCFE subtypes and the risk of avascular necrosis (AVN), particularly in moderate and severe cases, remains controversial. This study aims to report the midterm clinical and radiographic outcomes of the Modified Dunn procedure in treating SCFE, emphasizing the factors contributing to AVN development. Patients and methods: We conducted a prospective case series between 2014 and 2022, enrolling patients with moderate and severe SCFE who were treated using the Modified Dunn procedure by a single experienced hip surgeon. Patients were followed up clinically and radiologically for a minimum of two years. Results: Thirty-six patients (29 males, 7 females) with moderate and severe SCFE were included, with an average age of 14 years and a mean follow-up of 49.28 months (range: 24–118 months). Statistically significant improvements were observed in clinical and radiographic parameters at the final follow-up compared to pre-operative data. Five patients developed AVN, though no specific risk factor reached statistical significance regarding AVN development. While most AVN cases occurred early in the learning curve, this trend was not statistically significant. Conclusion: Modified Dunn is a safe and effective option for treating moderate to severe SCFE, offering superior femoral head realignment and patient-reported outcomes. When performed by experienced surgeons, it results in acceptable complication rates, including AVN. Level of evidence: Level IV Prospective Case series. [ABSTRACT FROM AUTHOR]

Background: Femoral neck fractures are rare but serious injuries in children and adolescents, often resulting from high-energy trauma and prone to complications like avascular necrosis (AVN) and nonunion. Even rarer is the development of slipped capital femoral epiphysis (SCFE) following femoral neck fracture, which presents unique diagnostic and treatment challenges. SCFE can destabilize the femoral head, with severe cases requiring complex surgical interventions. Case presentation: This report details a case of a 15-year-old male with autism spectrum disorder (ASD) who developed severe SCFE one month after treatment for a Delbet type III femoral neck fracture. The condition was managed with an Imhäuser intertrochanteric osteotomy (ITO), in situ fixation (ISF), and osteochondroplasty (OChP), supported by virtual surgical planning (VSP) and 3D-printed patient-specific instruments (PSIs) for precise correction and fixation. Discussion: The surgery was completed without complications. Six months after the operation, the patient exhibited a pain-free, mobile hip with radiographic evidence of fracture healing and no signs of AVN. Functional outcomes were favorable despite rehabilitation challenges due to ASD. Conclusions: The Imhäuser ITO, combined with ISF and OChP, effectively addressed severe SCFE after femoral neck fracture, minimizing AVN risk. VSP and PSIs enhanced surgical accuracy and efficiency, demonstrating their value in treating rare and complex pediatric orthopedic conditions. [ABSTRACT FROM AUTHOR]

Abstract Background Slipped capital femoral epiphysis (SCFE) is usually seen in patients with high body mass index (BMI) and endocrine diseases. SCFE is exceedingly rare among Cerebral palsy (CP) patients due to spasticity present in those patients. Percutaneous in situ fixation is the treatment option for SCFE patients. According to the literature, there’s no single case report with SCFE in a spastic CP patient with no prior history of trauma, seizure episodes, or endocrine disease. Case presentation We report a case of an 11-year-old spastic cerebral palsy (CP) patient with a physical status of level 5 motor function on the gross motor function classification system. He was brought by his mother to the clinic complaining of bilateral hip pain. The mother denied any history of trauma or any seizure episodes. The pain had started spontaneously. Physical examination showed severe spasticity and bilateral hip abduction with external rotation. Drehmann’s sign was positive. Bilateral hip radiographs revealed bilateral partial open femoral capital physis with evidence of SCFE bilaterally. Also, the Southwick angle was measured, and it was severe. The patient was taken to the operating room and treated with closed reduction and percutaneous in situ fixation. He was seen multiple times following surgical intervention, reporting pain relief, and showing complete wound healing. Conclusion This report concludes that paraplegic spastic CP patients may present with SCFE spontaneously without trauma, seizures, or an underlying endocrine disease. Also, severe spasticity might potentially be a risk factor for SCFE, although further investigations would be necessary to establish a conclusive link.

Purpose: Management of chronic moderate and severe slipped capital femoral epiphysis (SCFE) remains controversial. We propose that the modified trochanteric triplane osteotomy(MTTO) with a 1300 angled blade plate, without removal of bone wedge, is effective for addressing moderate and severe chronic SCFE. Methods: A retrospective review was performed on patients who underwent MTTO for moderate to severe chronic SCFE, with at least two years follow-up. Radiological outcomes assessed were osteotomy union, alpha angle, neck shaft angle, mechanical axis deviation and limb length discrepancy(LLD). Functional outcomes were assessed using modified Harris hip score, lower extremity functional scale (LEFS) and SF-36 questionnaire. Results: A total of 11 patients (13 hips) underwent MTTO for chronic SCFE, with a mean age of 12.9 ± 2.1 years. The pre-operative median modified Harris Hip Score was 73. 12 had severe slip and one had moderate slip. All the osteotomies went on to unite by two months. At an average of 37 months follow up, the mean neck shaft angle was 1290, mean alpha angle was 69.70, and mean LLD was 1.05 cm. There was significant improvement in the post-operative modified Harris hip score (p < 0.001), the median post-operative modified Harris hip score was 96, and the median LEFS was 78. One case had bone scan evidence of AVN, but did well with bisphosphonate therapy and one case had a superficial infection. Conclusion: MTTO is a safe and effective option for addressing deformities in chronic moderate and severe SCFE. However, a residual proximal femoral Cam deformity persists after this procedure which may need to be treated with a simultaneous or a staged osteochondroplasty. [ABSTRACT FROM AUTHOR]

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting adolescents, and can be encountered by any surgeon who sees children as part of their on-call commitment. There are a number of diagnostic and management challenges associated with this condition, in particular in how to manage children with severe and unstable disease. This article covers the diagnosis and classification of SCFE, allowing recognition of those patients requiring specialist paediatric referral. The surgical management of SCFE, including complex cases, is also discussed. [ABSTRACT FROM AUTHOR]

Background: Slipped capital femoral epiphysis (SCFE) is usually seen in patients with high body mass index (BMI) and endocrine diseases. SCFE is exceedingly rare among Cerebral palsy (CP) patients due to spasticity present in those patients. Percutaneous in situ fixation is the treatment option for SCFE patients. According to the literature, there's no single case report with SCFE in a spastic CP patient with no prior history of trauma, seizure episodes, or endocrine disease. Case presentation: We report a case of an 11-year-old spastic cerebral palsy (CP) patient with a physical status of level 5 motor function on the gross motor function classification system. He was brought by his mother to the clinic complaining of bilateral hip pain. The mother denied any history of trauma or any seizure episodes. The pain had started spontaneously. Physical examination showed severe spasticity and bilateral hip abduction with external rotation. Drehmann's sign was positive. Bilateral hip radiographs revealed bilateral partial open femoral capital physis with evidence of SCFE bilaterally. Also, the Southwick angle was measured, and it was severe. The patient was taken to the operating room and treated with closed reduction and percutaneous in situ fixation. He was seen multiple times following surgical intervention, reporting pain relief, and showing complete wound healing. Conclusion: This report concludes that paraplegic spastic CP patients may present with SCFE spontaneously without trauma, seizures, or an underlying endocrine disease. Also, severe spasticity might potentially be a risk factor for SCFE, although further investigations would be necessary to establish a conclusive link. [ABSTRACT FROM AUTHOR]

Case: Physeal stability in slipped capital femoral epiphysis (SCFE) depends on integrity of the hypertrophic zone. This in turn is affected by imbalance between circulating growth hormones and gonadal hormones. This case describes the occurrence of SCFE in a Māori (indigenous New Zealander) transgender girl, undergoing gender-affirming therapy with a gonadal-releasing hormone analog (GnRHa). Conclusion: Surgeons and clinicians alike should be aware that GnRHa in gender-affirming therapy may confer an additional risk factor, lowering the threshold required for SCFE to occur. Counseling patients about potentially increased risk, and need for timely presentation could be warranted, particularly in high-risk individuals. [ABSTRACT FROM AUTHOR]

Percutaneous screw fixation for slipped capital femoral epiphysis (SCFE) is a standard surgical procedure. This can be performed on a radiolucent “flattop” table or a fracture table, which holds the leg stable and can help with the serendipitous reduction of unstable SCFE's. Pivotal to success is accurate screw placement in the center of the epiphysis, adequate threads crossing the physis, and avoidance of screw penetration into the joint. Adequate fluoroscopic visualization in all planes is essential. We have used simultaneous biplanar fluoroscopy for accurate screw placement on a fracture table. The indications, techniques, pearls, and pitfalls of this procedure are presented in this study. Key Concepts: (1) Percutaneous screw fixation of SCFE is a mainstay of treatment. (2) Simultaneous biplanar fluoroscopy facilitates accurate screw placement. (3) Positioning on a fracture table can promote incidental reduction in cases where this is desirable. (4) Meticulous attention to room setup, patient positioning, and operative technique are necessary for success.

Background. Total hip arthroplasty (THA) is one of the most frequently performed and effective surgical procedures in patients with hip osteoarthritis of various origin. According to a variety of large arthroplasty registries, in 10-33% of cases, the causes of end-stage hip osteoarthritis in people under the age of 25 are such orthopedic diseases of the hip as dysplasia, SCFE and Perthes disease. However, there are practically no scientific publications examining the causes of the development of end-stage hip osteoarthritis in patients under the age of 21, as well as in children, in the foreign literature and there are none at all in the domestic literature. The aim of the study is to analyze the causes of the development of end-stage hip osteoarthritis requiring total hip arthropasty in children who had suffered major orthopedic diseases of the hip. Methods. The retrospective study is based on the medical records of 500 patients (530 hip joints) aged between 10 and 18 years (15.1±1.5) who had underwent total hip replacement at the Department of Hip Pathology of the G.I. Turner National Research Medical Center for Pediatric Traumatology and Orthopedics, in the period from 2008 to 2023. The main subject of the study was the anamnesis of the course of the orthopedic disease and previous treatment. Results. After studying the medical records and archival X-rays, we have identified the main diagnostic and tactical errors in the treatment of patients with major diseases of the hip, which are specific to childhood. Additionally, according to these nosological entities we have identified the most “endemic” federal regions and subjects of the Russian Federation. Conclusions. The main causes of the development of end-stage hip osteoarthritis requiring total hip arthroplasty in patients under the age of 18 with major orthopedic diseases of the hip are: diagnostic defects, methodological choice of both conservative and surgical treatment, and iatrogenic damage to the joint components.

ABSTRACT: Background: The American Medical Association and the National Institutes of Health recommend that patient education resources be written at sixth- and eighth-grade reading levels, respectively. However, many existing resources are written above this level. In addition, the majority of patient education resources are only available in English, despite the significant Spanish-speaking population in the United States. The purpose of this study was to determine the availability and readability of online patient education resources for slipped capital femoral epiphysis (SCFE) provided by the top-ranked pediatric orthopaedic hospitals and major pediatric orthopaedic professional societies. Methods: We performed a cross-sectional analysis to determine the availability of English and Spanish language resources for SCFE provided by the top pediatric orthopaedic hospitals and major professional societies. We then assessed the readability of available patient education materials via 3 measures of readability. Statistical analysis was performed using descriptive, univariate, and correlation analyses. Results: In total, 79.6% (39/49) of hospitals and 66.7% (2/3) of professional societies provided English language resources for SCFE. In contrast, Spanish language resources were provided by 34.7% (17/49) and 33% (1/3) hospitals and professional societies. English language resources scored significantly lower than Spanish language resources using the Flesch-Kincaid and Fernandez-Huerta reading ease scales, respectively (60.32 vs 65.89, P .05), but English language resources had a significantly higher grade level calculated by SMOG/SOL (11.9 vs 10.4, P 20% primary Spanish speakers (P 20%. Level of Evidence: III

ABSTRACT: Background: Routine slipped capital femoral epiphysis (SCFE) implant removal is controversial. Difficulty with hardware removal is well documented in SCFE patients, however, there is no biomechanical study demonstrating which specific aspect of screw morphology may be responsible for difficult removal. In this study, we compare the removal torques and work energy of fully and partially threaded cannulated SCFE screws from a bone simulation medium. Methods: 70 mm × 6.5 mm partially (20 mm threads) and fully threaded stainless-steel screws were tested by reversing them from a cured liquid resin medium. Peak torque and total work energy were recorded from a load cell apparatus during each trial. The mean peak torque and total work energy were compared between the partially threaded and fully threaded screw groups using Student’s t-test. P

Abstract Background In Sweden, most children with slipped capital femoral epiphysis (SCFE) are operated on with a single smooth pin or a short-threaded screw, allowing further growth of the femoral neck. Using the Swedish Pediatric Orthopaedic Quality registry, SPOQ, we investigated whether angular remodelling occurs adjacent to the proximal femoral epiphysis after fixation of SCFE using implants, allowing continued growth of the femoral neck. Methods During 2008–2010 a total national population of 155 children were reported to the SPOQ registry. Following our strict inclusion criteria, radiographs of 51 hips were further assessed. The lateral Head Shaft Angle (HSA), the Nötzli 3-point α-angle, the anatomic α-angle, and the Anterior Offset Ratio (AOR) on the first postoperative radiographs and at follow-up were measured to describe the occurrence of remodelling. Slip severity was categorised as mild, moderate or severe according to postoperative HSA. Results Mean and SD values for the change in HSA were 3,7° (5,0°), for 3-point α-angle 6,8° (8,9°), and anatomic α-angle 13,0° (16,3°). The overall increase in AOR was 0,038 (0.069). There were no significant differences between the slip severity groups. Conclusions We found limited angular remodelling after in situ fixation with smooth pins or short threaded screws for SCFE. The angular remodelling and the reduction of the CAM deformity was less than previously described after fixation of SCFE with similar implants. Results about the same magnitude with non-growth sparing techniques suggest that factors other than longitudinal growth of the femoral neck are important for angular remodelling.

Tim Cheok,1– 3 Matthew Jennings,1,4 Morgan Berman,1 Kanihska Williams,1,3 Jaideep Singh Rawat,1,5,6 Bruce K Foster1,5 1Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia; 2Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand; 3College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; 4Department of Plastics and Reconstructive Surgery, Women’s and Children’s Hospital, Adelaide, South Australia, Australia; 5Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia; 6Department of Orthopaedic Surgery, Women’s and Children’s Hospital, Adelaide, South Australia, AustraliaCorrespondence: Tim Cheok, Email tim.cheok@flinders.edu.auCase: We present a case of acute unstable valgus slipped capital femoral epiphysis (SCFE) in an 8-year-old female who presented after a trip and fall. The patient was managed with emergent closed reduction and percutaneous screw fixation and prophylactic fixation of contralateral side after 6 weeks. At 18-month follow-up, the patient was symptom free with a good range of movement and no evidence of slip progression, chondrolysis or avascular necrosis of the femoral head.Conclusion: We demonstrate that, in this case, closed reduction and percutaneous fixation provided satisfactory outcome at 18-month follow-up. This case highlights the need for both anteroposterior and lateral radiographs.Keywords: SCFE, closed reduction, percutaneous pinning, valgus slip

Background: The role of prophylactic pinning of the contralateral hip in unilateral SCFE is well established in patients with risk factors for developing contralateral slip. The effect of prophylactic pinning on the growth and morphology of the hip is not well documented in the literature. We aimed to study the effect of prophylactic pinning on the residual growth and morphology of the proximal femur. Materials & Methods: The institutional database was searched for all unilateral SCFE cases for the period 2011 to 2020. A total of 171 unilateral SCFE cases were identified. All the radiographs were scanned and those patients who had follow-up X-rays till skeletal maturity were included in the study. Prophylactic pinning was performed using 6.5 mm fully threaded cancellous screws in supine position on a radiolucent table. The following radiological parameters were measured on the post-operative X-rays and at skeletal maturity: (i) neck length (NL), (ii) neck-shaft angle (NSA), (iii) femoral offset (FO), (iv) articulo-trochanteric distance (ATD) and (iv) tip-apex distance (TAD) by two different observers. Results: The mean age of the cohort was 13.7 years. ATD decreased from the mean value of 25.67 mm in post-operative radiographs to 20.84 mm in final follow-up radiographs. The NL, FO, and TAD were found to be increasing with age with mean final follow-up values of 55.35 mm, 41.41 mm, and 6.19 mm respectively compared to post-operative mean values of 50.95 mm, 37.4 mm, and 4.69 mm. There was no significant change in the neck-shaft angle. The mean post-operative NSA was 132.9° and it was 131.8° at final follow-up radiographs. Conclusion: Prophylactic pinning in unilateral SCFE does not stop the growth of the proximal femur completely. The ATD decreases in all the patients with prophylactic screw fixation probably due to the discrepancy in growth between the trochanteric apophysis and proximal femoral physis. The clinical effects of this subtle change in the morphology of the proximal femur need further investigation. Level of Evidence: Level IV Case series. [ABSTRACT FROM AUTHOR]

Background: In Sweden, most children with slipped capital femoral epiphysis (SCFE) are operated on with a single smooth pin or a short-threaded screw, allowing further growth of the femoral neck. Using the Swedish Pediatric Orthopaedic Quality registry, SPOQ, we investigated whether angular remodelling occurs adjacent to the proximal femoral epiphysis after fixation of SCFE using implants, allowing continued growth of the femoral neck. Methods: During 2008–2010 a total national population of 155 children were reported to the SPOQ registry. Following our strict inclusion criteria, radiographs of 51 hips were further assessed. The lateral Head Shaft Angle (HSA), the Nötzli 3-point α-angle, the anatomic α-angle, and the Anterior Offset Ratio (AOR) on the first postoperative radiographs and at follow-up were measured to describe the occurrence of remodelling. Slip severity was categorised as mild, moderate or severe according to postoperative HSA. Results: Mean and SD values for the change in HSA were 3,7° (5,0°), for 3-point α-angle 6,8° (8,9°), and anatomic α-angle 13,0° (16,3°). The overall increase in AOR was 0,038 (0.069). There were no significant differences between the slip severity groups. Conclusions: We found limited angular remodelling after in situ fixation with smooth pins or short threaded screws for SCFE. The angular remodelling and the reduction of the CAM deformity was less than previously described after fixation of SCFE with similar implants. Results about the same magnitude with non-growth sparing techniques suggest that factors other than longitudinal growth of the femoral neck are important for angular remodelling. [ABSTRACT FROM AUTHOR]

Recent investigations suggest that physeal morphologic features have a major role in the capital femoral epiphysis stability and slipped capital femoral epiphysis (SCFE) pathology, with a smaller epiphyseal tubercle and larger peripheral cupping of the femoral epiphysis being present in hips with progressive SCFE compared to healthy controls. Yet, little is known on the causal versus remodeling nature of these associations. This study aimed to use preoperative magnetic resonance imaging (MRI) of patients with unilateral SCFE to perform a comparison of the morphology of the epiphyseal tubercle, metaphyseal fossa, and peripheral cupping in hips with SCFE versus the contralateral uninvolved hips. Preoperative MRIs from 22 unilateral SCFE patients were used to quantify the morphological features of the epiphyseal tubercle (height, width, and length), metaphyseal fossa (depth, width, and length), and peripheral cupping height in three dimension. The quantified anatomical features were compared between hips with SCFE and the contralateral uninvolved side across the whole cohort and within SCFE severity subgroups using paired t‐test. We found significantly smaller epiphyseal tubercle heights (p < 0.001) across all severities of SCFE when compared to their uninvolved contralateral side. There was a marginally smaller metaphyseal fossa length (p = 0.05) in SCFE hips compared to their contralateral uninvolved hips, with mild SCFE hips specifically having smaller fossa and epiphyseal lengths (p < 0.05) than their contralateral uninvolved side. There were no side‐to‐side differences in any other features of the epiphyseal tubercle, metaphyseal fossa and peripheral cupping across all severities (p > 0.05). These findings suggest a potential causal role of epiphyseal tubercle in SCFE pathogenesis. [ABSTRACT FROM AUTHOR]

Aim: Slipped capital femoral epiphyisis (SCFE) is a common pathology requiring immediate surgical intervention. This study aims to assess the clinical and radiological midterm outcomes of SCFE patients fixed with a single cannulated screw. Materials and Methods: We examined 7 hips of 6 patients treated with SCFE and evaluated mid-term results in our study. Medical records and radiographs were reviewed for slip characteristics. SCFE cases were classified as stable or unstable, and stability was confirmed by perioperative scopy. For clinical evaluation, the Heyman-Herndon classification was utilized. All patients underwent surgical treatment on a traction table while under general anesthesia. Results: The average degree of slippage was 41.4 (27-67) and the average body mass index was 26.9 (25.4-29.4). The mean duration of follow-up was 16 months (range: 13-31 months). İn the follow-up, shortness and limping were in no way observed. The comparative radiographs of the patients revealed no subchondral cyst, osteophytic formation, or subchondral sclerosis. In all patients, the range of motion in the operated hip was normal. Conclusion: Osteosynthesis with a single screw in the current position or after a slight reduction to be an adequate treatment for SCFE requiring emergency surgery. [ABSTRACT FROM AUTHOR]

Introduction: SCFE is a common hip adolescent disorder caused by biomechanical and biochemical factors, which requires early diagnosis and treatment. Case Report: A 14 year old boy was brought to the hospital with right hip pain and an antero-posterior and frog-leg lateral radiograph revealed a right Slipped Capital Femoral Epiphysis. Percutaneous fixation with a cannulated screw was performed and the patient was pain free after 1 week. Follow up visits were uneventful and the patient returned to pre-SCFE activities. Conclusion: Early diagnosis and prompt intervention are essential for successful management of SCFE with percutaneous fixation using cannulated screws. [ABSTRACT FROM AUTHOR]

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Abstract Background Slipped capital femoral epiphysis (SCFE) requires surgical treatment when diagnosed. The surgical management of moderate to severe SCFE remains an area of controversy among pediatric orthopedic surgeons. The severity of slippage, the viability of the femoral epiphysis, and the method of surgical management determine the long-term clinical and radiographical outcome. This study sought to evaluate the mid-term results of subcapital realignment of chronic stable slipped femoral epiphysis with open physis using surgical hip dislocation. Materials and methods This study was a prospective case series of adolescents with moderate or severe degrees of chronic SCFE who had undergone subcapital osteotomy using the surgical hip dislocation technique. The Harris Hip Score (HHS) was used to assess functional outcomes at 6 years of follow-up. A HHS of ≥ 80 points was considered satisfactory. Postoperative radiological outcomes were evaluated using epiphyseal-shaft angles and alpha angles. Postoperative complications were observed. Results This study included 40 patients, 32 (80%) males and 8 (20%) females, with a mean age of 14.1 ± 1.8 years. There was a statistically significant improvement in the mean HHS from 45 ± 12.3 preoperatively to 91.8 ± 11.6 points at 6 years of follow-up. The mean epiphyseal-shaft angle reduced from 60.5 ± 15.3° preoperatively to 10.3 ± 2.4° postoperatively, P

Introduction: MEN 2B syndrome is distinguished by the occurrence of medullary thyroid cancer, pheochromocytoma, mucosal neuromas, marfanoid features, and skeletal anomalies, including kyphoscoliosis, joint laxity, pes cavus, and, in a smaller number of cases, slipped capital femoral epiphysis (SCFE). Case report: We describe a case report of a 15-years-old patient with the diagnosis of the MEN2B syndrome with a rare manifestation of Slipped Capital Femoral Epiphysis (SCFE). A 15-year-old female presented to the orthopedics out-patient department (OPD) with complaints of pain around the right hip and knee and walking with a limp for approximately four months. Additionally, the feeling of enlarged thyroid gland was reported. X-ray confirmed the presence of the SCFE, while thyroid biopsy revealed the presence of medullary thyroid cancer (MTC). Thus, the diagnosis of MEN2B was made. Conclusion: Slipped capital femoral epiphysis (SCFE) can occasionally be a manifestation of MEN 2B syndrome. It is important for physicians to be aware of this association, as it can contribute to the early detection of a potentially life-threatening condition.

Abstract Bone scan is highly sensitive whole‐body imaging with relative low radiation in patients with non‐localized skeletal symptoms. Patient is 12‐year‐old boy with Down syndrome, suffering recent claudication and exacerbated left knee pain unable to walk even with crutches. Three‐dimensional Single photon emission computed tomography/Computed tomography (SPECT/CT) detected left slipped capital femoral epiphysis (SCFE) and secondary Avascular necrosis (AVN).

Background: Slipped capital femoral epiphysis (SCFE) causes degenerative changes warranting total hip arthroplasty (THA) in approximately 50% of patients by age 60 years. For severe SCFE, a reorienting intertrochanteric osteotomy (ITO) following in situ pinning (ISP) can decrease impingement with hip flexion, but by altering proximal femoral geometry, complicates subsequent conversion THA. We hypothesized that increasing implant survivorship would affect the most cost-effective treatment strategy (ISP followed by ITO [ISP+ITO] with later THA versus ISP alone [ISPa] with earlier THA) over a patient's lifetime.Methods: A state-transition Markov model was constructed to analyze the cost-effectiveness of either ISPa or ISP+ITO over a 60-year time horizon for children who have severe, stable SCFE. Transition probabilities associated with implant and native hip survivorship, state utilities, and costs were derived from the literature. Sensitivity analyses assessed the model robustness. Incremental cost-effectiveness ratios (ICERs) were compared to a societal willingness to pay (WTP) of $100,000 per quality-adjusted life year (QALY).Results: Over a 60-year horizon, ISPa was costlier ($291,836) than ISP+ITO ($75,227) but achieved overall better outcomes (51.4 QALYs ISPa versus 48.7 QALYs ISP+ITO), rendering ISPa cost-effective with an ICER of $80,980/QALY. Implant survivorship and time horizon were sensitive variables.Conclusion: Based upon current implant performance, ISPa with subsequent earlier THA is cost-effective when considering an individual's life expectancy and thereby deserves consideration in patients who have severe SCFE. Without clear level 1 clinical data, our economic model considers a difficult problem, while providing families and clinicians with a framework for understanding treatment options. [ABSTRACT FROM AUTHOR]

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting children and adolescents aged between 9 and 16 years, affecting approximately 10 per 100,000 children per year. The diagnosis of SCFE is often delayed, leading to an increased risk of complications. This study aims to provide the latest evidence concerning the causes of diagnostic delay and risk factors for SCFE and to educate general practitioners and paediatricians to help reduce delays in diagnosis and provide earlier therapeutic intervention. A literature search was conducted in the ScienceDirect and PubMed databases according to the PRISMA statement. Suitable studies for this systematic review included 22 articles discussing the aetiology of SCFE, risk factors, and causes of late diagnosis. Causes of delayed diagnosis include underestimation by patients, initial diagnostic approach by a non-orthopaedic professional, inadequate imaging, failure to recognize morphological changes, and variation in symptomatic presentation. The underlying risk factors for SCFE are likely part of a multifactorial process which involves anatomical variations and the metabolism of leptin, growth hormone, insulin, and other metabolic parameters. This review highlights the importance of early recognition and diagnosis of SCFE and proposes an algorithm for physicians to approach children who may have this condition. [ABSTRACT FROM AUTHOR]

Purpose: Slipped capital femoral epiphysis is a common pediatric hip disease and was associated with femoral retroversion, but femoral version was rarely measured. Therefore, mean femoral version, mean femoral neck version, and prevalence of femoral retroversion were analyzed for slipped capital femoral epiphysis patients. Methods: A retrospective observational study evaluating preoperative hip magnetic resonance imaging of 27 patients (49 hips) was performed. Twenty-seven untreated slipped capital femoral epiphysis patients (28 slipped capital femoral epiphysis hips and 21 contralateral hips, age 10–16 years) were evaluated (79% stable slipped capital femoral epiphysis, 22 patients; 43% severe slipped capital femoral epiphysis, 12 patients). Femoral version was measured using Murphy method on magnetic resonance imaging (January 2014–December 2021, rapid bilateral 3-dimensional T1 water-only Dixon-based images of pelvis and knee). All slipped capital femoral epiphysis patients underwent surgery after magnetic resonance imaging. Results: Mean femoral version of slipped capital femoral epiphysis patients (−1° ± 15°) was significantly (p < 0.001) lower compared to contralateral side (15° ± 14°). Femoral version of slipped capital femoral epiphysis patients had significantly (p < 0.001) wider range from –42° to 35° (range 77°) compared to contralateral side (−5° to 44°, range 49°). Mean femoral neck version of slipped capital femoral epiphysis patients (6° ± 15°) was lower compared to contralateral side (11° ± 12°). Fifteen slipped capital femoral epiphysis patients (54%) had absolute femoral retroversion (femoral version < 0°). Six of the 12 hips (50%) with severe slips and 4 of the 8 hips (50%) with mild slips had absolute femoral retroversion (femoral version < 0°). Ten slipped capital femoral epiphysis patients (40%) had absolute femoral neck retroversion (femoral neck version < 0°). Conclusion: Although slipped capital femoral epiphysis patients showed asymmetrically lower femoral version compared to contralateral side, there was a wide range of femoral version, underlining the importance of patient-specific femoral version analysis on preoperative magnetic resonance imaging. Absolute femoral retroversion was prevalent in half of slipped capital femoral epiphysis patients, in half of severe slipped capital femoral epiphysis patients, and in half of mild slipped capital femoral epiphysis patients. This has implications for anterior hip impingement and for surgical treatment with in situ pinning or femoral osteotomy (e.g. proximal femoral derotation osteotomy) or other hip preservation surgery. [ABSTRACT FROM AUTHOR]

Background: surgical hip dislocation (SHD) allows for 360 degrees view of the acetabulum and femoral head without risking the femoral head blood supply. Since then, this approach has been utilized by many surgeons for correction of the morphological abnormalities of the proximal femur with a reported low rate of complications. This work aims for assessing the outcome of the surgical hip dislocation in pediatric and adolescents with follow up for one year. Methods: This is a prospective study of 40 hips in 38 patients with intra articular hip pathology of variable causes, managed by surgical hip dislocation. Average age was 15 years old. Operative indications for the approach in this series were: Slipped capital femoral epiphysis (SCFE) in 18 cases, femoro acetabular impingement (FAI) in 7 cases, acetabular fracture in 4 cases, femoral head fractures in 3 cases, intraarticular hip lesion in 4 cases and intraarticular loose bodies in 4 cases. All patients were followed-up for a period ranging from 12 months to 18 months. Results: The overall results in 40 hips that were operated by surgical hip dislocation for various indications according to Harris Hip Score were:- 19 hips excellent results (47.5%), 11 hips good results (27.5%), 6 hips fair results (15%) and 4 hips poor results (10%). Conclusion: SHD by itself is as a safe and reliable technique that is associated with minimal risk of long term morbidity due to minimal, or no disruption of femoral head circulation if it is performed very carefully. [ABSTRACT FROM AUTHOR]

Abstract Background Treatment of SCFE is still controversial, especially in moderate and severe forms. Dunn osteotomy performed with the Ganz approach became very popular in the last decade, although it is a complicated and challenging surgical procedure with a risk of AVN. The aim of our study was to analyze the current literature verifying the effectiveness of this surgical procedure, with specific attention to the incidence of AVN and other complications. Main body A systematic review on the subject was performed according to the PRISMA guidelines. A literature search was performed by searching all published articles about the topic in the databases. The articles were screened for the presence of the following inclusion criteria: patients affected by slipped capital femoral epiphysis (SCFE) surgically treated by Dunn osteotomy using the Ganz surgical approach. All the patients affected by pathologies other than SCFE, treated without surgery or with procedures not including a surgical hip dislocation were excluded. Based on inclusion and exclusion criteria, 23 studies were included in our systematic review. Selected articles were published from 2009 to 2021 and they included 636 overall hips. According to the selected articles, Dunn osteotomy modified by Ganz, performed by an experienced surgeon, allows for anatomical reduction of moderate or severe SCFE with a low incidence of AVN. Conclusions The few papers with long term follow-up, reported no progression of hip osteoarthritis, however, since the patients are adolescent at surgery, longer follow-up studies are needed to validate this statement. It is still debated if better results are obtained in stable or unstable SCFE. The indication of this procedure in mild SCFE remains controversial. Level of evidence 3

Background: Slipped capital femoral epiphysis (SCFE) requires surgical treatment when diagnosed. The surgical management of moderate to severe SCFE remains an area of controversy among pediatric orthopedic surgeons. The severity of slippage, the viability of the femoral epiphysis, and the method of surgical management determine the long-term clinical and radiographical outcome. This study sought to evaluate the mid-term results of subcapital realignment of chronic stable slipped femoral epiphysis with open physis using surgical hip dislocation. Materials and methods: This study was a prospective case series of adolescents with moderate or severe degrees of chronic SCFE who had undergone subcapital osteotomy using the surgical hip dislocation technique. The Harris Hip Score (HHS) was used to assess functional outcomes at 6 years of follow-up. A HHS of ≥ 80 points was considered satisfactory. Postoperative radiological outcomes were evaluated using epiphyseal-shaft angles and alpha angles. Postoperative complications were observed. Results: This study included 40 patients, 32 (80%) males and 8 (20%) females, with a mean age of 14.1 ± 1.8 years. There was a statistically significant improvement in the mean HHS from 45 ± 12.3 preoperatively to 91.8 ± 11.6 points at 6 years of follow-up. The mean epiphyseal-shaft angle reduced from 60.5 ± 15.3° preoperatively to 10.3 ± 2.4° postoperatively, P < 0.001. The mean alpha angle reduced from 72.5 ± 10.1° preoperatively to 40.4 ± 6.4°, P < 0.001. Four (10%) patients showed femoral head avascular necrosis (AVN). Conclusions: Subcapital realignment of chronic SCFE can achieve satisfactory clinical and radiological outcomes, but femoral head AVN remains a risk. Level of evidence Level IV. [ABSTRACT FROM AUTHOR]

Aims: We sought to determine if the magnitude of anterior physeal separation (APS) in slipped upper femoral epiphysis was a predictor for the subsequent development of avascular necrosis (AVN). Anterior Physeal Separation (APS) is defined as the distance between the anterior lip of the bony capital epiphysis and the lateral corresponding point of the adjacent bony metaphysis on the Lauenstein radiographic view. It represents hinging of the posterior aspect of the metaphysis with the anterior epiphysis lifting away from its adjacent metaphysis, indicating instability and potential vulnerability of the vessels.Patients and Methods: A retrospective review of all patients treated regionally for slipped upper femoral epiphysis over a 9 year period (2010-2018 inclusive) were identified. Data regarding demographics, radiological parameters and outcomes was recorded. APS was measured on a Launestein radiograph view, with the patient supine, the hip and knee are flexed to 40°, and the hip externally rotated 45°, with film-focus distance of 100 cm. Analysis of the APS was performed to validate a threshold above which AVN occurs.Results: We identified 147 hips in 142 patients, of which 5 had bilateral slips at the time of presentation. Average anterior physeal separation was 3.8 ± 1.8 mm, with higher grade slips having significantly greater APS values. Increased APS values were seen with Loder "unstable" slips. Seven hips (4.8%) developed AVN, and in these cases the APS was significantly larger than those who did not (8.5 ± 1.4 Vs 3.9 ± 1.7; p < 0.001). Receiver operator curve analysis demonstrated a critical value of 7.5 mm was associated with a 100% sensitivity and 98.6% specificity for AVN. We identified some grade II/moderate slips with high APS values had similar outcomes to grade III/severe slips, and therefore suggest that APS may serve to alert the surgeon on counselling patients on the risk of developing AVN and to consider strategies to minimise the risk of AVN.Conclusions: APS is sensitive, specific, accurate and reliable for the association with AVN in SUFE. Its values closely reflect the high AVN rates seen in acute and unstable SUFE. This risk is greatest if the magnitude of APS exceeds the critical value of 7.5 mm. [ABSTRACT FROM AUTHOR]

Purpose of Review: Femoracetabular impingement (FAI) is a common source of hip pain in children and adolescents. While nonoperative therapies and open surgical procedures can be effective, hip arthroscopy is a minimally invasive treatment option with substantial benefit. The purpose of this paper is to evaluate the current role of hip arthroscopy in treating FAI within the pediatric population. This article examines its efficacy through a review of hip arthroscopy outcomes in the contemporary orthopaedic literature. Recent Findings: Morphologic changes in the acetabulum and proximal femur seen in FAI can be attributed to a multitude of etiologies—including idiopathic FAI, Legg-Calve-Perthes, and slipped capital femoral epiphysis. In general, arthroscopic treatment of FAI secondary to these conditions leads to statistically significant improvements in pain and patient-reported outcomes in the short and long term. In the pediatric athlete, repetitive stress on the hip perpetuates FAI and can drastically hinder performance. Hip arthroscopy allows for a high rate of return to sport with minimal morbidity in this population. Summary: Overall, pediatric hip arthroscopy is effective in treating FAI secondary to a wide variety of conditions. Despite its clinical benefits, patients and their families should be counseled regarding alternative treatments, potential complications, and return to play. [ABSTRACT FROM AUTHOR]

Slipped capital femoral epiphysis (SCFE) is a fracture that results from displacement of the proximal femoral epiphysis from the femoral neck. SCFE can be caused by various endocrinopathies that lead to bone weakening in both adult and pediatric patients. We report a rare case of suprasellar germinoma presenting with SCFE in an 11-year-old female patient. The findings of this case further support the need to consider pituitary lesions as the underlying cause of endocrine deficiences leading to SCFE.

Bone scan is highly sensitive whole‐body imaging with relative low radiation in patients with non‐localized skeletal symptoms. Patient is 12‐year‐old boy with Down syndrome, suffering recent claudication and exacerbated left knee pain unable to walk even with crutches. Three‐dimensional Single photon emission computed tomography/Computed tomography (SPECT/CT) detected left slipped capital femoral epiphysis (SCFE) and secondary Avascular necrosis (AVN). [ABSTRACT FROM AUTHOR]

Epiphysiolysis (or Slipped Capital Femoral Epiphysis, SCFE) is a hip disorder involving children during prepubescence age. Traditionally, it is defined as a postero-medial slippage of the femoral epiphysis on the metaphysis, but, considering that femoral epiphysis is almost “stored” in the acetabulum, it could be better defined as laterally and anterior slippage of femoral metaphysis under the epiphysis.

Das Femoroacetabuläre Impingement Syndrom (FAIS) ist eine wichtige Differenzialdiagnose des Leistenschmerzes bei jugendlichen sportlichen Patient/-innen. Es ist am häufigsten durch eine Cam Morphologie verursacht. Diese entsteht kurz vor Verschluss der proximalen Wachstumsfuge am Femur. Sportliche Belastungen sind auslösend für die Entstehung einer sogenannten epiphysären Extension, die die Offset Veränderung am Kopf-Schenkelhals-Übergang verursacht. Die wichtigste Differenzialdiagnose zur primären Cam Morphologie ist die Epiphysiolysis capitis femoris (ECF). Eine systematische klinische und radiologische Abklärung ist obligat. Bei jugendlichen Patienten mit FAIS ist ein konservativer Therapieversuch der erste Schritt. Schlägt dieser fehl, ist die operative Sanierung mit Hüftarthroskopie indiziert. Hier werden gute Ergebnisse mit einer hohen Return-to-Sport Rate erzielt. Femoroacetabular impingement syndrome (FAIS) is an important differential diagnosis of groin pain in adolescent athletic patients. It is most commonly caused by cam morphology. This occurs just before closure of the proximal growth plate of the femur. High sports activtiy triggers the development of a so-called epiphyseal extension, which causes the offset change at the femoral head-neck junction. The most important differential diagnosis to primary cam morphology is slipped capital femoral epiphysis (SCFE). A systematic clinical and radiological workup is mandatory. In adolescent patients with FAIS, a conservative therapy attempt is the first step. If this fails, surgical repair with hip arthroscopy is indicated. Good results with a high return-to-sport rate are achieved. [ABSTRACT FROM AUTHOR]

Abstract Background Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10–14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed. Methods Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. Results From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%). Conclusion National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy. Level of evidence III

Background: Slipped capital femoral epiphysis is due to proximal femur physis failure in adolescent patients. Early iatrogenic closure of proximal growth cartilage in children with significant residual growth potential causes complications such as coxa breva, coxa vara, and lower limb length inequalities. The Free-Gliding SCFE Screw System is a self-extending cannulated screw used in Slipped Capital Femoral Epiphysis (SCFE) fixation and femoral neck fractures. Materials and Method: We conducted a retrospective study on 16 patients. All patients under 11 years old were treated by telescopic cannulated screws fixation. The youngest patient was 7 years old. Results: Out of the 22 operated hips, 2 screws have failed, thus resulting in a lack of telescoping of the screw. We discovered an average lengthening of approximately 10 mm at 24 months postoperative check-up in 20 hips in which lengthening took place. According to the Notzli method, none of the patients had an alpha angle value greater than 48 degrees. Conclusion: Fixation with telescopic screw for SCFE in patients less than 11 years old, with mild to moderate slippage, allows the continuous growth and remodeling of the proximal femur, thus avoiding deformities such as coxa breva, coxa vara, FAI, AVN, limb length discrepancies and also allows good range of motion. [ABSTRACT FROM AUTHOR]

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder affecting children and adolescents aged between 9 and 16 years, affecting approximately 10 per 100,000 children per year. The diagnosis of SCFE is often delayed, leading to an increased risk of complications. This study aims to provide the latest evidence concerning the causes of diagnostic delay and risk factors for SCFE and to educate general practitioners and paediatricians to help reduce delays in diagnosis and provide earlier therapeutic intervention. A literature search was conducted in the ScienceDirect and PubMed databases according to the PRISMA statement. Suitable studies for this systematic review included 22 articles discussing the aetiology of SCFE, risk factors, and causes of late diagnosis. Causes of delayed diagnosis include underestimation by patients, initial diagnostic approach by a non-orthopaedic professional, inadequate imaging, failure to recognize morphological changes, and variation in symptomatic presentation. The underlying risk factors for SCFE are likely part of a multifactorial process which involves anatomical variations and the metabolism of leptin, growth hormone, insulin, and other metabolic parameters. This review highlights the importance of early recognition and diagnosis of SCFE and proposes an algorithm for physicians to approach children who may have this condition.

A one-year-old neutered Maine Coon cat was admitted to the clinic with sudden onset of lameness in the right pelvic leg persisting for around 2 days. A clinical examination revealed lack of weight bearing on the right pelvic limb, minor bilateral atrophy of gluteal muscles and acute pain upon palpation of the right hip joint. Radiographs taken in the dorsoventral projection revealed a large radiolucent area in the proximal femoral epiphysis, surface remodeling of the femoral head and subcartilaginous sclerotization in the right pelvic limb, which were indicative of slipped capital femoral epiphysis. Radiolucent foci on the femoral head was observed in the left pelvic limb. The patient was examined in the Esaote Vet-MRI Grande scanner (0.25 T). The scans revealed complete separation of the femoral head, the presence of a hematoma and bone marrow edema in the right limb, as well as widening of the growth plate, bone marrow edema and the presence of a subcartilaginous cyst in the left limb. Resection arthroplasty of the right femoral head was performed, and the slipped femoral head was subjected to a histopathological examination. The aim of this study was to evaluate the use of low-field MRI for diagnosing slipped capital femoral epiphysis.