Slipped Capital Femoral Epiphysis (SCFE)
SCFE is a disorder of the adolescent hip where the femoral neck slips upward and forward relative to the head (like a scoop of ice cream falling off a cone). It is a type of Salter-Harris Type I fracture.
1. Clinical Features
- Demographic: Obese adolescent males (10-16 years). Associated with hypothyroidism/hypogonadism.
- Symptoms: Pain in groin or Knee (Referred pain!). Limp.
- Signs: Drehmann Sign (Hip moves into external rotation during flexion). Limited Internal Rotation.
2. Classification
- Stable: Can bear weight.
- Unstable: Cannot bear weight (High risk of AVN).
3. Management
- Surgery (Standard): In Situ Pinning with a single cannulated screw. Do NOT attempt to reduce the slip aggressively (causes AVN).
- Complications:
- Chondrolysis: Acute cartilage necrosis (stiff painful hip).
- AVN: Especially in unstable slips.
25 Practice MCQs
Q1. The typical patient with SCFE is:
Answer: A). Hormone imbalances + Weight = Slip.
Q2. In SCFE, the femoral neck moves:
Answer: A). Leaving the head posterior and inferior.
Q3. Trethowan's Sign refers to:
Answer: A). Normally, the line should cut through the superior part of the head.
Q4. Drehmann Sign is:
Answer: A). Due to the retroverted position of the neck.
Q5. Referred pain in SCFE is commonly felt in the:
Answer: A). Always examine the hip in a child with knee pain!
Q6. Stable SCFE is defined as:
Answer: A). Loder classification.
Q7. The treatment of choice for Stable SCFE is:
Answer: A). Stabilizes the physis to prevent further slip.
Q8. Chondrolysis is characterized by:
Answer: A). Often caused by screw penetration into the joint.
Q9. Which endocrine disorders are associated with SCFE?
Answer: A). Consider screening if patient is <10 or >16 years old.
Q10. Unstable SCFE has a high risk of:
Answer: A). Up to 50% risk due to vascular kinking.
Q11. Prophylactic pinning of the contralateral hip is considered because:
Answer: A). Especially in younger patients or those with endocrine issues.
Q12. The physis in SCFE is:
Answer: A). "Pre-slip" sign.
Q13. "Ice cream falling off the cone" describes:
Answer: A). Classic analogy.
Q14. Range of motion loss is primarily in:
Answer: A). Hip rests in ER.
Q15. Why is forceful manipulation/reduction contraindicated?
Answer: A). Accept the deformity to save the head.
Q16. Salter-Harris classification of SCFE is:
Answer: A). Fracture through the hypertrophic zone of the physis.
Q17. "Blanch Sign of Steel" on X-ray indicates:
Answer: A). Seen on AP view.
Q18. Post-op weight bearing for stable SCFE:
Answer: A). Until callous is seen or symptoms subside.
Q19. Southwick Angle is used to measure:
Answer: A). Mild <30, Moderate 30-50, Severe >50.
Q20. Pistol Grip Deformity is a late sequela resembling:
Answer: A). The neck becomes thick, causing impingement.
Q21. Imhauser Osteotomy is used for:
Answer: A). Realigns the limb.
Q22. The screw should ideally be placed:
Answer: A). Maximizes stability and avoids joint penetration.
Q23. How many screws are typically used?
Answer: A). More screws = higher risk of complication.
Q24. Acute-on-chronic slip means:
Answer: A). Prodromal symptoms existed > 3 weeks.
Q25. Renal Osteodystrophy can cause SCFE due to:
Answer: A). "Atypical SCFE".
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