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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]

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]

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]

Aims Slipped upper femoral epiphysis (SUFE) has well documented biochemical and mechanical risk factors. Femoral and acetabular morphologies seem to be equally important. Acetabular retroversion has a low prevalence in asymptomatic adults. Hips with dysplasia, osteoarthritis, and Perthes’ disease, however, have higher rates, ranging from 18% to 48%. The aim of our study was to assess the prevalence of acetabular retroversion in patients presenting with SUFE using both validated radiological signs and tomographical measurements. Methods A retrospective review of all SUFE surgical cases presenting to the Royal Children’s Hospital, Melbourne, Australia, from 2012 to 2019 were evaluated. Preoperative plain radiographs were assessed for slip angle, validated radiological signs of retroversion, and standardized postoperative CT scans were used to assess cranial and mid-acetabular version. Results In all, 116 SUFEs presented in 107 patients who underwent surgical intervention; 47 (52%) were male, with a mean age of 12.7 years (7.5 to 16.6). Complete radiological data was available for 91 patients (99 hips) with adequate axial CT imaging of both hips. Overall, 82 patients (82%) underwent pinning in situ (PIS), with subcapital realignment surgery (SRS) performed in 17 patients (18%) (slip angles > 75°). Contralateral prophylactic PIS was performed in 72 patients (87%). On the slip side, 62 patients (68%) had one or more radiological sign of retroversion. Tomographical acetabular retroversion was more pronounced cranially than caudally of the acetabulum on both the affected side and the contralateral side (p < 0.001) as expected in the normal population. Increasing severity of the slip was found to be directly proportional to the degree of reduction in cranial and central acetabular version (p < 0.05) in the SUFE hips. Conclusion Acetabular retroversion is more prevalent in patients with SUFE than previously reported, and have been shown be correlated to the severity of the slip presentation. The presence of radiological signs of acetabular retroversion could be used to justify prophylactic contralateral pinning. Cite this article: Bone Jt Open 2022;3(2):158–164.

Purpose: To identify a specific factor that can support the decision for prophylactic fixation in unilateral slipped capital femoral epiphysis. Methods: This retrospective cohort study included a total national population of 379 children diagnosed with slipped capital femoral epiphysis from 2007 to 2013. Regression analysis used information on slip severity, clinical classification of the index hip, age, sex, age-adjusted body mass index, the difference in epiphyseal–diaphyseal angle, and comorbidity to identify any risk factor for the subsequent development of a slip in the contralateral hip. Four observers evaluated the triradiate cartilage following the modified Oxford bone score grade. The occurrence of later development of a contralateral slip in different stage of physeal closure was used to analyze the sensitivity and specificity for this method. Results: This study’s only predictor for a subsequent contralateral slip was chronological age. At age 13 years or older, 1/15 in girls and 3/65 in boys suffered from a slip in the contralateral hip. Thus, when using age <13 years as a test for deciding when to do prophylactic fixation, the sensitivity would be 88% and specificity 51% for preventing contralateral slip. However, the correlation between the four different observers was too low to be considered useful when assessing the triradiate cartilage for skeletal maturity. Conclusion: We would advocate a prophylactic fixation for children <13years diagnosed with a unilateral slipped capital femoral epiphysis as an easy-to-use algorithm. Level of evidence: level II. [ABSTRACT FROM AUTHOR]

There is limited evidence on the outcomes of Total Hip Arthroplasty (THA) in Slipped Capital Femoral Epiphysis (SCFE) patients. This systematic review aims to evaluate the current literature in terms of survival rate, functional outcomes, complications and types of implants of THA in SCFE patients. Following the established methodology of PRISMA guidelines, PubMed, Cochrane library, ScienceDirect and Ovid MEDLINE were systematically searched from inception to September 2018. The search criteria used were: (“total hip arthroplasty’’ OR ‘’total hip replacement’’ OR “hip arthroplasty’’ OR ‘’hip replacement’’) AND (‘’slipped capital femoral epiphysis’’ OR ‘’slipped upper femoral epiphysis’’ OR ‘’femoral epiphysis’’). Ten studies were finally included in the analysis and were qualitatively appraised using the Newcastle-Ottawa tool. Variables were reported differently between studies. The sample size varied from 12 to 374 THAs. A total of 877 patients undergone 915 THAs. The mean reported follow-up ranged from 4.4 to 15.2 years and the mean patients’ age at the time of THA from 26 to 50 years. Four studies specified the type of implants used, with 62% being uncemented, 24% hybrid (uncemented cup/cemented stem) and 14% cemented. All but three studies reported the mean survival of implants that ranged from 64.9% to 94.8%. A limited number of complications were mentioned. There was a tendency for more favorable functional outcomes in modern studies. Modern THA-studies in SCFE patients showed improvement of survivorship, clinical outcomes and patient satisfaction. Future higher-quality studies are necessary to estimate long-term postoperative outcomes better.

Purpose This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE). Methods This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses. Results We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8-20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chisquared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions. Conclusion A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage. [ABSTRACT FROM AUTHOR]

Slipped upper femoral epiphysis (SUFE) is a common hip disorder of adolescence, with unknown aetiology. The typical patient presenting with SUFE is an overweight adolescent boy, who reports pain in the groin, thigh or knee, with an associated limp. SUFE is defined as stable when the patient can walk, with or without support. The current treatment of choice for stable SUFE is by fixation in situ with a single screw. This method has a high probability of success, with minimal risk of osteonecrosis or chondrolysis. In those patients presenting with an unstable SUFE, immediate closed reduction and fixation with a single screw provides the best chance of a satisfactory result. [ABSTRACT FROM AUTHOR]

Abstract Background Several aspects of slipped capital femoral epiphysis (SCFE) treatment remain controversial. Loder’s work has been instrumental in changing our understanding and approach to the management of the condition when he introduced the concept of “slip instability” and showed that avascular necrosis (AVN) developed in 47% of unstable slips but none of the stable slips. As the two types of SCFE behave differently in terms of presentation, progress and complications, we approached them as two different conditions to highlight these differences. This paper focuses on treatments of stable SCFE. Materials and methods An extensive literature search was carried out from multiple databases. One thousand six hundred and twenty-three citations were screened. Three hundred and sixteen full publications were obtained for further scrutiny. Fifty-eight studies (2262 hips) were included in the review. These studies evaluated 6 interventions. AVN was chosen as a surrogate for bad outcome. Secondary outcomes were chondrolysis (CL), femoro-acetabular impingement (FAI), osteoarthritis (OA) and patients’ reported outcomes. The latter were pooled when they met our predefined criteria. Results The type of surgical intervention was an important risk factor. Pinning in situ (PIS) was associated with the lowest AVN rate (1.4%). Moreover, the CL, FAI and OA rates were relatively low in patients who underwent PIS. These were not translated into high patient satisfaction rates among these patients, with only 47% reporting an “excellent” outcome. In contrast, 87% of patients who underwent Ganz surgical dislocation reported an “excellent” outcome. The Ganz surgical dislocation was associated with an AVN rate of 3.3%; double that observed in pinning in situ. Conclusion Pinning in situ is the best treatment for mild and moderate stable slip. Ganz surgical dislocation gives higher patient satisfaction for severe stable slip but the risk of AVN is doubled compared with pinning in situ. Devices that allow continued growth may be better than standard screws. Level of evidence Level III.

Abstract Background Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in children 9–15 years old. This is a population-based study in Sweden presenting the epidemiology for SCFE. Methods In a prospective cohort study, we analysed pre- and postoperative radiographs, medical records for all children treated for SCFE in Sweden 2007–2013, demographic data, severity of slip and surgical procedures performed. Results We identified 379 Swedish children with primary SCFE 2007–2013; 162 girls, median age 11.7 (7.2–15.4) years, and 217 boys, median age 13 (3.8–17.7) years. The average annual incidence was 4.4/10000 for girls and 5.7/10000 for boys 9–15 years old. Obesity or overweight was found in 56% of the girls and in 76% of the boys. As an initial symptom, 66% of the children had hip/groin pain and 12% knee pain. At first presentation, 7% of the children had bilateral SCFE. Prophylactic fixation was performed in 43%. Of the remaining children, 21% later developed a contralateral slip. Fixation with implants permitting further growth was used in >90% of the children. Femoral neck osteotomy was performed for 11 hips. Conclusions The annual average incidence 2007–2013 in Sweden showed a mild increase for girls. The male-to-female ratio was lower than previous regional data from Sweden. Overweight or obesity is one major characteristic for boys with SCFE but to a less extent for girls. Knee pain as initial symptom cause a delay in diagnosis. Most hospitals in Sweden treat

Abstract Background Primary hyperparathyroidism (PHPT) is uncommon among children with an incidence of 1:300,000. This diagnosis is often missed in children in contrast to adults where it is detected at a pre symptomatic stage due to routine blood investigations. Etiology of PHPT can be due to adenoma, hyperplasia or rarely carcinoma. Case presentation A 12 year old Sri Lankan girl presented with progressive difficulty in walking since 1 year. On examination she had bilateral genu valgum. Skeletal survey revealed valgus deformity of knee joints, bilateral subluxation of upper femoral epiphysis(SUFE), epiphyseal displacement of bilateral humeri, rugger jersey spine and subperiosteal bone resorptions in lateral aspects of 2nd and 3rd middle phalanges. There were no radiological manifestations of rickets. Metabolic profile revealed hypercalcemia with hypophosphatemia. Intact parathyroid hormone levels were elevated at 790 pg/ml. Vitamin D levels were deficient. She had low bone mineral density with Z score of −3.4. Vitamin D supplementation resulted in worsening of hypercalcemia without reduction in PTH levels. Tc 99 Sestamibi uptake scan showed abnormal tracer retention in left inferior pole of thyroid. A large parathyroid gland was removed with histology favoring parathyroid adenoma. Post operatively she developed hypocalcemia. Bilateral osteotomy was done for SUFE and further surgeries for correction of limb deformities planned. Conclusion PHPT in children is usually diagnosed late when irreversible organ damage has occurred. Children can present with non specific symptoms involving gastrointestinal, musculoskeletal, renal and neurological systems. PHPT can cause disarray in bone and epiphysis in children during pubertal growth spurt. Genu valgum and SUFE are rare skeletal manifestations in PHPT and only 10 cases of genu valgum and 9 cases of SUFE have been reported up to now. So far no cases have been reported on epiphyseal displacement of humeri. Awareness regarding the occurrence of these rare skeletal manifestations especially during puberty is important for early diagnosis to prevent irreversible outcomes.

Paediatric orthopaedic surgery can be an unfamiliar and challenging field with the potential for devastating consequences. This article discusses late deformity associated with humeral supracondylar fractures and slipped capital femoral epiphysis (SCFE). Common complications include loss of fixation, mal-reduction, avascular necrosis and growth disturbance. Many cases result in reoperation and revision surgery associated with significant morbidity. We discuss the risk factors, aetiology, tips to avoid them and management options based on current evidence. [ABSTRACT FROM AUTHOR]

Purpose Slipped upper femoral epiphysis (SUFE) is one of the most common adolescent hip pathologies in children with potential for life-long morbidity secondary to avascular necrosis (AVN). The primary aim is to determine an up-to-date demographic of SUFE, as well as current trends in presentation and radiological characteristics. Secondary aims are to quantify prophylactic fixation and subsequent contralateral SUFE. Methods Between 01 January 2013 and 31 December 2015, all cases of SUFE were identified in Northern Ireland. Patient demographics, slip characteristics and outcomes are presented and the incidence rates were calculated using census data. Temporal changes in incidence, compared with a previous cohort, are demonstrated. Results A total of 56 patients (80 hips) were identified. Based on census data, SUFE incidence has declined from 7.14 to 4.69/100,000 population aged < 16 years. Male cases predominated by > 2:1 ratio, and tended to be older than female cases. Approximately 75% of patients were above the 75th centile for age-sex adjusted body weight. Knee pain as a presenting symptom led to a delay in diagnosis. Prophylactic fixation was performed in 25.9%, with contralateral slips occurring in 27.5%. AVN occurred in 7.4% and remained static. Conclusion The incidence of SUFE has declined ~34% in our region. When SUFE occurs, knee pain often results in a delay in definitive diagnosis, and commands clinical vigilance to avoid delays in diagnosis. Patients in our region should be aware of a 1-in-4 contralateral slip rate. Overall, AVN rates remain static and are acceptable, despite the declining incidence of SUFE. [ABSTRACT FROM AUTHOR]

Purpose Previous work has examined the impact of delay of diagnosis in slipped capital femoral epiphysis (SCFE) but not the impact of delay in treatment after radiographic diagnosis. Due to requirements for long distance transportation from less developed regions for many of our patients, our hospital was able to study variation in time between diagnosis and surgery for SCFE, as related to slip severity. Methods This is a retrospective review of patients treated for SCFE between 2005 and 2014 at a tertiary care paediatric hospital. Demographics, time between diagnosis and surgery, radiographic deformity (Southwick angle), postoperative complications and need for further surgery were variables of interest. Statistical analysis included Pearson and Spearman rank correlations and chi-squared tests. Results The study sample included 147 hips (119 patients). Mean time between radiographic diagnosis and surgery was 20.9 days (sd 46, 0 to 321). The mean Southwick angle (SA) at the time of surgery was 31.9° (sd 19.6°, 1° to 83°). There was a significant relationship between increased delay and increased SA (0.34, p < 0.001). Increased SA was correlated with need for future significant surgery (0.27, p < 0.01). Patients from less-developed regions, with barriers to timely care, had moderate and severe deformity (SA) (p < 0.01), and required significant further surgery more often than SCFE patients from the local population (p < 0.01) Conclusion The unique referral environment of our hospital provided an opportunity to examine traditional recommendations for treating SCFE promptly after radiographic diagnosis. Delay in treatment is correlated with increased radiographic deformity. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism usually affects the elderly. Juvenile hyperparathyroidism is rare and poses specific diagnostic and therapeutic problems. We report the case of two young female patients, aged 14 and 19 years, with primary hyperparathyroidism detected due to femoral head involvement. One of those patients had slipped upper femoral epiphysis. Hyperparathyroidism only affected bone in both cases. No patient had a family history of this disease. Primary hyperparathyroidism was associated with solitary and benign parathyroid adenoma in both patients. They underwent complicated adenomectomy by persistent hypocalcaemia. This last was associated with hypoparathyroidism exacerbated by hungry bone syndrome, requiring substitutive vitaminocalcic therapy. It is well known that primary hyperparathyroidism rarely occurs in young subjects. Renal involvement is the most common clinical manifestation of hyperparathyroidism. Bone involvement and, in particular, slipped femoral epiphyses are an uncommon mode of revelation. [ABSTRACT FROM AUTHOR]

Background: Several aspects of slipped capital femoral epiphysis (SCFE) treatment remain controversial. Loder's work has been instrumental in changing our understanding and approach to the management of the condition when he introduced the concept of "slip instability" and showed that avascular necrosis (AVN) developed in 47% of unstable slips but none of the stable slips. As the two types of SCFE behave differently in terms of presentation, progress and complications, we approached them as two different conditions to highlight these differences. This paper focuses on treatments of stable SCFE.Materials and Methods: An extensive literature search was carried out from multiple databases. One thousand six hundred and twenty-three citations were screened. Three hundred and sixteen full publications were obtained for further scrutiny. Fifty-eight studies (2262 hips) were included in the review. These studies evaluated 6 interventions. AVN was chosen as a surrogate for bad outcome. Secondary outcomes were chondrolysis (CL), femoro-acetabular impingement (FAI), osteoarthritis (OA) and patients' reported outcomes. The latter were pooled when they met our predefined criteria.Results: The type of surgical intervention was an important risk factor. Pinning in situ (PIS) was associated with the lowest AVN rate (1.4%). Moreover, the CL, FAI and OA rates were relatively low in patients who underwent PIS. These were not translated into high patient satisfaction rates among these patients, with only 47% reporting an "excellent" outcome. In contrast, 87% of patients who underwent Ganz surgical dislocation reported an "excellent" outcome. The Ganz surgical dislocation was associated with an AVN rate of 3.3%; double that observed in pinning in situ.Conclusion: Pinning in situ is the best treatment for mild and moderate stable slip. Ganz surgical dislocation gives higher patient satisfaction for severe stable slip but the risk of AVN is doubled compared with pinning in situ. Devices that allow continued growth may be better than standard screws.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Primary hyperparathyroidism (PHPT) is uncommon among children with an incidence of 1:300,000. This diagnosis is often missed in children in contrast to adults where it is detected at a pre symptomatic stage due to routine blood investigations. Etiology of PHPT can be due to adenoma, hyperplasia or rarely carcinoma. Case presentation: A 12 year old Sri Lankan girl presented with progressive difficulty in walking since 1 year. On examination she had bilateral genu valgum. Skeletal survey revealed valgus deformity of knee joints, bilateral subluxation of upper femoral epiphysis(SUFE), epiphyseal displacement of bilateral humeri, rugger jersey spine and subperiosteal bone resorptions in lateral aspects of 2nd and 3rd middle phalanges. There were no radiological manifestations of rickets. Metabolic profile revealed hypercalcemia with hypophosphatemia. Intact parathyroid hormone levels were elevated at 790 pg/ml. Vitamin D levels were deficient. She had low bone mineral density with Zscoreof -3.4. Vitamin D supplementation resulted in worsening of hypercalcemia without reduction in PTH levels. Tc 99 Sestamibi uptake scan showed abnormal tracer retention in left inferior pole of thyroid. A large parathyroid gland was removed with histology favoring parathyroid adenoma. Post operatively she developed hypocalcemia. Bilateral osteotomy was done for SUFE and further surgeries for correction of limb deformities planned. Conclusion: PHPT in children is usually diagnosed late when irreversible organ damage has occurred. Children can present with non specific symptoms involving gastrointestinal, musculoskeletal, renal and neurological systems. PHPT can cause disarray in bone and epiphysis in children during pubertal growth spurt. Genu valgum and SUFE are rare skeletal manifestations in PHPT and only 10 cases of genu valgum and 9 cases of SUFE have been reported up to now. So far no cases have been reported on epiphyseal displacement of humeri. Awareness regarding the occurrence of these rare skeletal manifestations especially during puberty is important for early diagnosis to prevent irreversible outcomes. [ABSTRACT FROM AUTHOR]

Background: Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in children 9-15 years old. This is a population-based study in Sweden presenting the epidemiology for SCFE.Methods: In a prospective cohort study, we analysed pre- and postoperative radiographs, medical records for all children treated for SCFE in Sweden 2007-2013, demographic data, severity of slip and surgical procedures performed.Results: We identified 379 Swedish children with primary SCFE 2007-2013; 162 girls, median age 11.7 (7.2-15.4) years, and 217 boys, median age 13 (3.8-17.7) years. The average annual incidence was 4.4/10000 for girls and 5.7/10000 for boys 9-15 years old. Obesity or overweight was found in 56% of the girls and in 76% of the boys. As an initial symptom, 66% of the children had hip/groin pain and 12% knee pain. At first presentation, 7% of the children had bilateral SCFE. Prophylactic fixation was performed in 43%. Of the remaining children, 21% later developed a contralateral slip. Fixation with implants permitting further growth was used in >90% of the children. Femoral neck osteotomy was performed for 11 hips.Conclusions: The annual average incidence 2007-2013 in Sweden showed a mild increase for girls. The male-to-female ratio was lower than previous regional data from Sweden. Overweight or obesity is one major characteristic for boys with SCFE but to a less extent for girls. Knee pain as initial symptom cause a delay in diagnosis. Most hospitals in Sweden treat <2 children annually. [ABSTRACT FROM AUTHOR]

SUFE is a common hip disorder of adolescence, with unknown aetiology. The typical patient presenting with SUFE is an overweight adolescent boy, who reports pain in the groin, thigh or knee, with an associated limp. SUFE is defined as stable when the patient can walk, with or without support. The current treatment of choice for stable SUFE is by fixation in situ with a single screw. This method has a high probability of success, with minimal risk of osteonecrosis or chondrolysis. In those patients presenting with an unstable SUFE, immediate closed reduction and fixation with a single screw provides the best chance of a satisfactory result. [ABSTRACT FROM AUTHOR]

Background: Slipped capital femoral epiphysis (SCFE) is commonly treated with in situ pinning. However, a severe slip may not be suitable for in situ pinning because the required screw trajectory is such that it risks perforating the posterior cortex and damaging the remaining blood supply to the capital epiphysis. In such cases, an anteriorly placed screw may also cause impingement. It is also possible to underestimate the severity of the slip using conventional radiographs. The aim of this study was to describe and evaluate a novel method for calculating the true deformity in SCFE and to assess the interobserver and intraobserver reliability of this technique. Methods: We selected 20 patients with varying severity of SCFE who presented to our institution. Cross-sectional imaging [either axial computed tomography (CT) scans or magnetic resonance imaging (MRI) scans] and anteroposterior (AP) pelvis radiographs were assessed by four reviewers with varying levels of experience on two occasions. The degree of slip on the axial image and on the AP pelvis radiographs were measured and, from this, the oblique plane deformity was calculated using the method as popularised by Paley. The intraclass correlation coefficient (ICC) was calculated to determine the interobserver and intraobserver reliabilities between and amongst the raters. Results: The interobserver reliability for the calculated oblique plane deformity in SCFE ICC was 0.947 [95 % confidence interval (CI) 0.90-0.98] and the intraobserver reliability for the calculated oblique plane deformity of individual raters ranged from 0.81 to 0.94. The deformity in the oblique plane was always greater than the deformity measured in the axial or the coronal plane alone. Conclusion: This method for calculating the true deformity in SCFE has excellent interobserver and intraobserver reliability and can be used to guide treatment options. This technique is a reliable and reproducible method for assessing the degree of deformity in SCFE. It may help orthopaedic surgeons with varying degrees of experience to identify which hips are suitable for in situ pinning and those which require surgical dislocation and anatomical reduction, given that plain radiographs in a single plane will underestimate the true deformity in the oblique plane. Level of evidence: Level II diagnostic study. [ABSTRACT FROM AUTHOR]

Background: Slipped upper femoral epiphysis (SUFE) is the gradually acquired malalignment of the upper femoral epiphysis (capital) and the proximal femoral metaphysis. SUFE is uncommon in India, and there are no previous studies on outcome and clinical characteristics of patients with SUFE from India. This study evaluates the presentation, disease associations and outcome of SUFE from a tertiary care centre in India. Materials and Methods: Twenty six consecutive children with SUFE seen over a period of 4 years were reviewed. The clinical presentations, severity of the slip, surgical interventions (n=30) were assessed. Twenty one boys and five girls with a mean age 13.1 years (range 10-16 years) were included in the study. Four children had bilateral involvement. There were 4 rural and 22 urban children from the eastern and southern states of the country. The presentation was acute in 7, acute on chronic in 5, and chronic in 14, with a mean duration of symptoms of 51 days (range 3-120 days). Slips were stable in 16 and unstable in 10 children. Two children had adiposogenital syndrome. Body mass index was high in 12 out of 23 children. Vitamin D levels were low in 20 out of 21 children, with a mean vitamin D level of 12.61 ± 5 ng/ml. Eighteen children underwent in situ pinning. Eight children underwent capital realignment. Results: Clinical outcome as assessed by Merle df Aubigne score was excellent in 6, good in 10, fair in 6 and poor in 1. Half of the in situ fixation patients underwent osteoplasty procedure for femoroacetabular impingement and 5 more were symptomatic. The head neck offset and α angle after in situ pinning were -1.12 ± 3 mm and 66.05 ± 9.7° respectively and this improved to 8.7 mm and 49‹, respectively, after osteoplasty. One child in the pinning group had chondrolysis. Eight patients with severe slip underwent capital realignment. Mean followup was 20.15 months. The anterior head neck offset and α angle were corrected to 6.8 ± 1.72 mm and 44.6 ±7.0°, respectively. Two children with unstable slip in the capital realignment group had avascular necrosis which was diagnosed at presentation by bone scan. Conclusion: High BMI, vitamin D deficiency and endocrine disorders are associated with SUFE in India and should be evaluated as some of these are amenable to prevention and treatment. Most patients treated with in situ pinning developed femoroacetabular impingement. The early results after capital realignment procedure are encouraging and help to avoid a second procedure which is needed in a majority of patients who underwent in situ pinning. [ABSTRACT FROM AUTHOR]

Abstract: We have investigated the results of primary total hip arthroplasty (THA) performed in patients with slipped upper femoral epiphysis (SUFE). Through the New Zealand Joint Registry, we identified all patients with SUFE undergoing primary THA (n = 117) and all patients with primary osteoarthritis (OA) undergoing primary THA (n = 40 589) between January 1, 1999, and December 31, 2008. Baseline information, operative characteristics, and postoperative outcomes were analyzed and compared between the SUFE and the OA groups. There was no significant difference in postoperative Oxford Hip Score or revision rate between the 2 groups. Our results support THA as a successful surgical option in the management of degenerative arthritis in SUFE, with comparable functional outcomes and revision rates to THA performed for primary OA. [Copyright &y& Elsevier]

Patients with moderate and severe slipped capital femoral epiphysis (SCFE) develop osteoarthritis earlier in life in association with mechanical impingement. To correct deformity and diminish impingement, we performed epiphysiodesis combined with an Imhauser intertrochanteric osteotomy (ITO) in moderate and severe slipped capital femoral epiphysis. We downgraded the angle of the head relative to the acetabulum into an angle corresponding to a mild slip or even an anatomical position. Our hypothesis is that the avoidance of anterior impingement at an early stage can prevent the development of osteoarthritis. The results of 28 patients (32 hips) were evaluated. Outcome parameters were SF-36, Harris Hip Score, range of motion, Kellgren–Lawrence score, chondrolysis and avascular necrosis. After a median follow-up of 8 (range 2–25) years, the group was clinically, functionally and socially performing well. Radiologically, there was no sign of chondrolysis or avascular necrosis, and more than 80% of the patients did not show any signs of osteoarthritis. Based on these results, we conclude that a one-stage Imhauser ITO combined with epiphysiodesis performed on patients with moderate and severe SFCE gives satisfactory results. [ABSTRACT FROM AUTHOR]

Abstract: The incidence of slipped upper femoral epiphysis is 10 per 100 000 in the age groups most at risk. The commonest presenting features include groin, thigh, or knee pain, with limp, hip ‘irritability’, external rotation, and restriction of flexion and abduction. In girls the peak incidence is between 10 and 13 and in boys between the ages of 12 and 15. Most cases are idiopathic and associated with a high body mass index. Slips usually occur through the proliferative and hypertrophic zones of the growth plate. The chief complications are avascular necrosis and chondrolysis. The treatment of a slip is usually by pinning in situ. A severe slip is very disabling, even if AVN is avoided. Surgery to correct the deformity is either by some variant of intra-capsular neck osteotomy, or by an extra-capsular osteotomy. In the past, intra-capsular osteotomy was blamed for causing AVN, but recent experience suggests that it is the setting in which it is considered [severe, often unstable slips] which is the cause of the AVN, not the procedure itself. [Copyright &y& Elsevier]

Abstract: The limping child is a common reason for attendances to the emergency department. It is very likely that the Foundation Years doctor will have to assess and treat these patients. While the large majority of the patients have typically benign diagnoses, there are very important causes of a limp in a child that must be excluded. These include malignancy and acute sepsis of the hip. It is important to determine the salient features on history and examination and to conduct the appropriate investigations. This article outlines how children with a limp may present clinically and details the acute assessment that must be carried out to exclude the rare but potentially devastating causes of a limp. The details of diagnosing the more common conditions causing a limp in a child are also described. [Copyright &y& Elsevier]

Summary: Slipped upper femoral epiphysis is a common adolescent hip disorder. The classic image of the obese hypogonadal male child presenting with a limp is widely known; despite appearances few of these children demonstrate an endocrine disorder. Most are idiopathic, but some are associated with obesity, younger bone age, race and biomechanical factors. Historical treatments, such as spica casts, have been abandoned and in situ pinning is widely held to be the optimum treatment. The more severe slips frequently require osteotomy and may go on to require salvage surgery. This article presents a review of the aetiology, features and treatment options available. [Copyright &y& Elsevier]

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Aims: The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE)., Methods: This was an anonymized comprehensive cohort study, with a nested consented cohort, following the the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) framework. A total of 143 of 144 hospitals treating SCFE in Great Britain participated over an 18-month period. Patients were cross-checked against national administrative data and potential missing patients were identified. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants., Results: A total of 486 children (513 hips) were newly affected, with a median of two patients (interquartile range 0 to 4) per hospital. The annual incidence was 3.34 (95% confidence interval (CI) 3.01 to 3.67) per 100,000 six- to 18-year-olds. Time to diagnosis in stable disease was increased in severe deformity. There was considerable variation in surgical strategy among those unable to walk at diagnosis (66 urgent surgery vs 43 surgery after interval delay), those with severe radiological deformity (34 fixation with deformity correction vs 36 without correction) and those with unaffected opposite hips (120 prophylactic fixation vs 286 no fixation). Independent risk factors for avascular necrosis (AVN) were the inability of the child to walk at presentation to hospital (adjusted odds ratio (aOR) 4.4 (95% CI 1.7 to 11.4)) and surgical technique of open reduction and internal fixation (aOR 7.5 (95% CI 2.4 to 23.2)). Overall, 33 unaffected untreated opposite hips (11.5%) were treated for SCFE by two-year follow-up. Age was the only independent risk factor for contralateral SCFE, with age under 12.5 years the optimal cut-off to define 'at risk'. Of hips treated with prophylactic fixation, none had SCFE, though complications included femoral fracture, AVN, and revision surgery. PROMs demonstrated the marked impact on quality of life on the child because of SCFE., Conclusion: The experience of individual hospitals is limited and mechanisms to consolidate learning may enhance care. Diagnostic delays were common and radiological severity worsened with increasing time to diagnosis. There was unexplained variation in treatment, some of which exposes children to significant risks that should be evaluated through randomized controlled trials. Cite this article: Bone Joint J  2022;104-B(4):519-528.

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Background: Slipped capital femoral epiphysis (SCFE) results in alterations to femoral head anatomy, predisposing patients to degenerative hip disease at a young age. Total hip arthroplasty (THA) is performed to relieve symptoms and improve function. However, it can be associated with a variable outcomes and little evidence exists on the functional outcomes, complications and revision rate following such procedures., Purpose: The aim of this systematic review is to determine the safety and effectiveness of performing hip arthroplasty in patients with degenerative hips secondary to SCFE., Methodology: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature review was conducted of MEDLINE and Embase. Both single-arm and comparative studies were included. The outcomes of interest were functional scores, post-operative complications and revision rate., Results: Six studies fit the inclusion criteria. Of these, five were retrospective single-arm studies and one was a retrospective comparative study based on registry data.All studies reported significant improvement in hip function and quality of life after THA. An overall revision rate of 11.9% was reported, occurring at a mean of 6.5 years (0.75-18.7 years).THA in patients after SCFE leads to improved functional outcomes that are comparable to patients receiving THA for osteoarthritis. The revision rate appears to be higher than is reported in patients undergoing THA for osteoarthritis at mid-term follow-up. Further prospective comparative studies are needed to evaluate the efficacy of the treatment in more detail. Cite this article: EFORT Open Rev 2021;6:539-544. DOI: 10.1302/2058-5241.6.200038., Competing Interests: ICMJE Conflict of interest statement: The author declares no conflict of interest relevant to this work., (© 2021 The author(s).)

A 13-year-old boy who had hemophilia A was reported with pain in the left thigh and hip on walking. He had no history of trauma. Severe hemophilia A is diagnosed with a Factor VIII level of <1 iu/dl. The presumptive diagnosis was that of a spontaneous bleed into the hip joint. Factor VIII mutational analysis revealed a C to G substitution at nucleotide 6683 which results in a cystine change at codon 2194. However, the symptoms persisted and an X-ray demonstrated the presence of an acute on chronic slip of the upper femoral epiphysis. The patient was transferred to the center treating his hemophilia where the hip was pinned in situ under cover with Factor VIII. This case demonstrates the need to be aware of a possible traumatic diagnosis of hip pain in a hemophiliac child with a longstanding history of spontaneous bleeding into joints. [ABSTRACT FROM AUTHOR]

The management of slipped upper femoral epiphysis is controversial and evolving as insight into the condition develops. Loder introduced the concept of slip stability and demonstrated a strong association between poor outcome and instability. Almost half of patients with unstable slip developed femoral head osteonecrosis. This has been influential in surgeons' choice of treatments. Some surgeons have adopted a minimal intervention approach such as pinning in situ or gentle reduction and pinning whereas others advocated an urgent open reduction and stabilisation of slip using various surgical techniques. In this review we analysed the influence of various interventions, timing of surgery and severity of the slip on the outcome of unstable slip., (Copyright © 2016. Published by Elsevier Ltd.)

Slipped upper femoral epiphysis (SUFE) is the most common hip disorder to affect adolescents. Controversy exists over the optimal treatment of severe slips, with a continuing debate between in situ fixation versus corrective surgery. We present our experience in a series of 57 patients presenting with severe unilateral SUFE (defined > 50°) managed with a subcapital cuneiform osteotomy. Between 2001 and 2011, 57 patients (35 male, 22 female) with a mean age of 13.1 years (9.6 to 20.3, SD 2.3) were referred to our tertiary referral institution with a severe slip. The affected limb was rested in slings and springs before corrective surgery which was performed via an anterior Smith-Petersen approach. Radiographic analysis confirmed an improvement in mean head-shaft slip angle from 53.8(°) (standard deviation (SD) 3.2) pre-operatively to 9.1(°) (SD 3.1) post-operatively, with minimal associated femoral neck shortening. In total 50 (88%) patients were complication free at a mean follow-up of seven years (2.8 to 13.9 years, SD 3). Their mean Oxford hip score was 44 (37 to 48) and median visual analogue pain score was 0 out of 10 (interquartile range 0 to 4). A total of six patients (10.5%) developed avascular necrosis requiring further surgery and one (1.8%) patient developed chondrolysis but declined further intervention. This is a technically demanding operation with variable outcomes reported in the literature. We have demonstrated good results in our tertiary centre., (©2015 The British Editorial Society of Bone & Joint Surgery.)