Slipped capital femoral epiphysis is a condition likely to be encountered by all practising orthopaedic surgeons. A sound knowledge of the risk factors, presentation, investigation and management is essential to prevent the potentially significant consequences of missing the diagnosis. We present an overview of the condition, along with a review of the relevant literature to date.
AronssonD.D., LoderR.T., BreurG.J., WeinsteinS.L.Slipped capital femoral epiphysis: current concepts.J Am Acad Orthop Surg2006; 14: 666–79. Review.
2.
UglowM.G., ClarkN.M.The management of slipped capital femoral epiphysis.J Bone Joint Surg Br2004; 86: 631–5.
3.
MullinsM.M., SoodM., Hashemi-NejadA., CatterallA.The management of avascular necrosis after slipped capital femoral epiphysis.J Bone Joint Surg Br2005; 87: 1669–74.
4.
LoderR.T.Controversies in slipped capital femoral epiphysis.Orthop Clin North Am2006; 37: 211–21.
5.
FishkinZ., ArmstrongD.G., ShahH., PatraA., MihalkoW.M.Proximal femoral physis shear in slipped capital femoral epiphysis–a finite element study.J Pediatr Orthop2006; 26: 291–4.
6.
GalbraithR., GelbermanR.H., HajekP.C.. Obesity and decreased femoral anterversion in adolescence.J Orthop Res1987; 5: 523–8.
7.
KordelleJ., MillisM., JoleszF.A., KikinisR., RicholtJ.A.Three-dimensional analysis of the proximal femur in patients with slipped capital femoral epiphysis based on computed tomography.J Pediatr Orthop2001; 21: 179–82.
8.
SorensenK.H.Slipped upper femoral epiphysis. Clinical study on aetiology.Acta Orthop Scand1968; 39: 499–517.
9.
HarrisW.The endocrine basis for slipping of the upper femoral epiphysis: an experimental study.J Bone Joint Surg Br1950; 32: 5–11.
10.
LoderR.The demographics of slipped capital femoral epiphysis. An international multicenter study.Clin Orthop Relat Res1996; 322: 8–27.
11.
LoderR.T., WittenbergB., DeSilvaG.Slipped capital femoral epiphysis associated with endocrine disorders.J Pediatr Orthop1995; 15: 349–56.
12.
Wong-ChungJ., Al-AaliY., FaridI., Al-AradiA.A common HLA phenotype in slipped capital femoral epiphysis?Int Orthop2000; 24: 158–9.
13.
RahmeD., ComleyA., FosterB., CundyP.Consequences of diagnostic delays in slipped capital femoral epiphysis.J Pediatr Orthop B2006; 15: 93–7.
14.
LoderR.T., StarnesT., DikosG., AronssonD.D.Demographic predictors of severity of stable slipped capital femoral epiphyses.J Bone Joint Surg Am2006; 88: 97–105.
15.
LoderR.L., AronsonD.D., GreenfieldM.L.The epidemiology of SCFE: a study of children in Michigan.J Bone Joint Surg Am1993; 75: 1141–7.
KleinA., JoplinR.J., ReidyJ.A., HanelinJ.Slipped capital femoral epiphysis. Early diagnosis and treatment facilitated by “normal” roentgenograms.J Bone Joint Surg Am1952; 34: 233–9.
18.
SteelH.The metaphyseal blanch sign of slipped capital femoral epiphysis.J Bone Joint Surg Am1986; 68: 920–2.
19.
AadalenR., WeinerD., HoytW., HerndonC.Acute slipped capital femoral epiphysis.J Bone Joint Surg Am1974; 56: 1473–87.
20.
LoderR., RichardsB., ShapiroP., ReznickL., AronsonD.Acute slipped capital femoral epiphysis: the importance of physeal stability.J Bone Joint Surg Am1993; 75: 1134–40.
21.
JacobsB.Diagnosis and natural history of slipped femoral capital epiphysis.In: Instructional Course Lectures, American Academy of Orthopedic Surgeons1972; 21: 167–73.
22.
HanssonG., BillingL., HogstedtB., WallinJ.Long term results after nailing in situ of slipped upper femoral epiphysis.J Bone Joint Surg Br1998; 80: 70–7.
23.
KallioP.E., PatersonD.C., FosterB.K., LequesneG.W.Classification in slipped capital femoral epiphysis. Sonographic assessment of stability and remodeling.Clin Orthop Relat Res1993; 294: 196–203.
24.
JerreR., KarlssonJ., RomanusB., Wallin. Does a single device prevent further slipping of the epiphysis in children with slipped capital femoral epiphysis?Arch Orthop Trauma Surg1997; 116: 348–51.
25.
KummD.A., LeeS.H., HackenbrochM.H., RüttJ.Slipped capital femoral epiphysis: a prospective study of dynamic screw fixation.Clin Orthop Relat Res2001; 384: 198–207.
26.
CanaleS.T., CasillasM., BantaJ.V.Displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis.J Pediatr Orthop1997; 17: 212–5.
27.
DunnD., AngelJ.Replacement of the femoral head by open operation in severe adolescent slipping of the upper femoral epiphysis.J Bone Joint Surg Br1978; 60: 394–403.
28.
FishJ.Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. A follow-up note.J Bone Joint Surg Am1994; 76: 46–59.
29.
DeRosaG.P., MullinsR.C., KlingT.F.Jr.. Cuneiform osteotomy of the femoral neck in severe slipped capital femoral epiphysis.Clin Orthop Relat Res1996; 322: 48–60.
30.
BirringG.S., Hashemi-NejadA., CatterallA.Outcomes of subcapital cuneiform osteotomy for the treatment of severe slipped capital femoral epiphysis after skeletal maturity.J Bone Joint Surg Br2006; 88: 1379–84.
31.
KramerW.G., CraigW.A., NoelS.Compensating osteotomy at the base of the femoral neck for slipped capital femoral epiphysis.J Bone Joint Surg Am1976; 58: 796–800.
32.
SouthwickW.O.Osteotomy through the lesser trochanter for slipped capital femoral epiphysis.J Bone Joint Surg Am1967; 49: 807–35.
33.
SchaiP., ExnerG., HanschO.Prevention of secondary coxarthrosis in SCFE: a long-term follow-up study after corrective inter-trochanteric osteotomy.J Pediatr Orthop B1996; 5: 135–43.
34.
FergusonA.B., HoworthM.B.Slipping of the upper femoral epiphysis. A study of seventy cases.J Am Med Assoc1931; 97: 1867–72.
35.
MeierM.C., MeyerL.C., FergusonR.L.Treatment of slipped capital femoral epiphysis with a hip spica cast.J Bone Joint Surg Am1992; 74: 1522–9.
36.
MooneyJF3rd, PodeszwaD.A.Management of unstable/acute slipped capital femoral epiphysis: results of a survey of the POSNA membership.J Pediatr Orthop2005; 25: 162–6.
37.
TokmakovaK.P., StantonR.P., MasonD.E.Factors influencing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis.J Bone Joint Surg Am2003; 85: 798–801.
38.
PetersonM.D., WeinerD.S., GreenN.E., TerryC.L.Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction.J Pediatr Orthop1997; 17: 648–54.
39.
DietzF.R.Traction reduction of acute and acute-on-chronic slipped capital femoral epiphysis.Clin Orthop Relat Res1994; 302: 101–10.
40.
JerreR., BillingL., HanssonG., WallinJ.The contralateral hip in patients primarily treated for unilateral slipped upper femoral epiphysis. Long-term follow-up of 61 hips.J Bone Joint Surg Br1994; 76: 563–7.
41.
StasikelisP.J., SullivanC.M., PhillipsW.A., PolardJ.A.Slipped capital femoral epiphysis. Prediction of contra-lateral involvement.J Bone Joint Surg Am1996; 78: 1149–55.
42.
KummD.A., SchmidtJ., EisenburgerS.H., RüttJ., HackenbrochM.H.Prophylactic dynamic screw fixation of the asymptomatic hip in slipped capital femoral epiphysis.J Pediatr Orthop1996; 16: 249–53.
43.
BidwellT.A., Susan StottN.Sequential slipped capital femoral epiphyses: who is at risk for a second slip?ANZ J Surg2006; 76: 973–6.
44.
CarneyB., WeinsteinS.Natural history of untreated chronic SCFE.Clin Orthop Relat Res1996; 322: 43–7.
45.
CarneyB.T., WeinsteinS.L., NobleJ.Long-term follow-up of slipped capital femoral epiphysis.J Bone Joint Surg Am1991; 73: 667–74.
46.
KennedyJ.G., HreskoM.T., KasserJ.R.. Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis.J Pediatr Orthop2001; 21: 189–93.
47.
TudiscoC., CateriniR., FarsettiP., PotenzaV.Chondrolysis of the hip complicating slipped capital femoral epiphysis: long-term follow-up of nine patients.J Pediatr Orthop B1999; 8: 107–11.
48.
JerreR., BillingL., KarlssonJ.Loss of hip motion in slipped capital femoral epiphysis: a calculation from the slipping angle and the slope.J Pediatr Orthop B1996; 5: 144–50.
