Journal Reading

1. Slipped Capital Femoral Epiphysis: Diagnosis

and Management
2. Slipped capital femoral epiphysis: current
management strategies

Co-Ass Bagian Bedah RSI Sultan Agung Semarang

Coass : Asa Aulia Abdah
Supervisor : dr. Arief Indra Perdana Prasetya, Sp.OT
 Definition
SCFE is defined as the
posterior and inferior
slippage of the proximal
femoral capital epiphysis
on the metaphysis (femoral
neck), which occurs
through the epiphyseal
plate (growth plate).

Source : Slipped Capital Femoral Epiphysis: Diagnosis and Management

https://www.merckmanuals.com/home/children-s-health-issues/bone-disorders-in-children/slipped-capital-femoral-epiphysis-scfe#
Epidemiology
0.33 to 24.58 in 100,000
children 8–15 years of age
DEPEND ON SEX
AND ETHNICH

Average age : 12 th vs 11.2 th

Average cases : 13.35 vs 8.07 cases in 100,000

These seasonal
variations are
obese children thought to be linked
The prevalence of vitamin D
present earlier to differences in
insufficiency/deficiency in children
than lightweight vitamin D production
and adolescents is higher in blacks
children and levels at different
and/or obese children than in
times of the year.
Caucasian and/or nonobese ones

overall peak of presentation in mid-August.

Source : Slipped capital femoral epiphysis: current management strategies, Orthopedic Research and Reviews
 etiology

obesity growth spurts endocrine

disorders (less
commonly)

Source : Slipped Capital Femoral Epiphysis: Diagnosis and Management

 Physical Examination, Sign and Symptom
Sign
• limping and pain that is poorly localized to the
hip, groin, thigh, or knee (most common)
• Knee or distal thigh pain (15%)

Physical Examination
• the patient may have an antalgic gait or may be
unable to bear weight with a severe slip
• Limited internal rotation of the hip
• Obligatory external rotation (Drehmann sign) is
noted in the involved hip of patients with SCFE
when the hip is passively flexed to 90 degrees

Source : Slipped Capital Femoral Epiphysis: Diagnosis and Management

 Radiology
sign

Source : Slipped Capital Femoral Epiphysis: Diagnosis and Management

 DIFFERE
NTIAL
DIAGNO
SIS

Source : Slipped Capital Femoral Epiphysis: Diagnosis and Management

 classification

Angle (southwick) Functional (loder classification) Onset (temporal)

stable unstable

• accounts for about 90% of all slips • often has severe hip pain that does not allow gait
• generally has a much better prognosis than unstable • Medical history is often positive for hip, thigh, and
SCFE knee pain and previous trauma (of a minor entity
• usually an obese teen with a brief history of pain that that does not justify the condition).
is poorly localized, and it can affect the hip, groin, • If the patient is unable to ambulate even with
thigh, and knee crutches, it is considered unstable.
• may also present a slight or mild limp, gait with
external rotation of the foot, limitation of internal
rotation of the hip, or with fixed position in external
rotation and flexion of the hip (Drehmann sign)
Source : Slipped capital femoral epiphysis: current management strategies, Orthopedic Research and Reviews
Slipped Capital Femoral Epiphysis: Diagnosis and Management
 classification

Angle (southwick) Functional (loder classification) Onset (temporal)

By measuring the angle between the head and Acute

femoral diaphysis on X-ray anteroposterior and
axial projections.The angle is then compared sudden epiphyseal displacement and the presence of
with the unaffected side for one-side lesion or symptoms for
with normal values for bilateral involvemen

Acute-on-chronic
Sligh <30°
symptoms occur abruptly with exacerbation of pain and
Moderate 30-60° inability to walk, with lower-limb pain for >3 weeks

Severe >60° Chronic

Arround >85% cases

symptoms are present for >3 weeks, with remission and
relapse.
Source : Slipped capital femoral epiphysis: current management strategies, Orthopedic Research and Reviews
 TREATMENT
• Once the diagnosis of SCFE is made, the patient should be placed on non–weight-bearing crutches
or in a wheelchair and urgently referred to an orthopedic surgeon familiar with the treatment of SCFE.
• The initial goals of treatment are to prevent slip progression and avoid complications.
• A forceful relocation of the injury should not be attempted; such maneuvers can result in avascular
necrosis caused by restricted blood supply to the femoral head
TREATMEN
T
OPTIONS
Compensatory
Insitu fixation osteotomies

Prophylactic pinning SHD

(Surgical Hip Dislocation)

Source : Slipped capital femoral epiphysis: current management strategies, Orthopedic Research and Reviews
Slipped Capital Femoral Epiphysis: Diagnosis and Management
 Prophylactic pinning Compensatory osteotomies

• Bilateral involvement in SCFE

ranges from 14% to 63%. This risk
can increase to up to 80% when • Compensatory osteotomies are not
diagnosed at a very young age and intended to achieve an anatomically
up to 100% when endocrinopathies aligned epiphysis, since the correction
are associated at the site of deformity is reported to risk
• prophylactic pinning of a the blood supply to the epiphysis
radiographically and clinically • The most commonly used are
normal hip should be reserved to a intertrochanteric osteotomies and
selected cohort of patients, such as cuneiform osteotomies at the base of
very young children, presence of the neck
endocrinopathy, obese patients,
and those whose follow-up is
thought to be difficult.
Source : Slipped capital femoral epiphysis: current management strategies, Orthopedic Research and Reviews
Source : https://www.researchgate.net/figure/A-C-A-A-14-year-old-male-patient-underwent-prophylactic-pinning-on-the-asymptomatic_fig3_329674659
Compensatory osteotomies
 SHD
In situ fixation • An important role is played by SHD,
also called the modified Dunn
procedure
• Classical treatment of SCFE
• posterolateral dissection of the
• This technique aims to prevent the
retinaculum to allow some trimming
increase of displacement until
of the callus formation at the
eventual closure of the growth plate,
posterior neck, adding a trochanteric
and is widely used for both stable
osteotomy to facilitate the
and unstable SCFE, regardless of
procedure. The space created,
the degree of deformity
reaching from the head–neck
• Several methods have been
junction to the axilla with the greater
described, from the implant of one
trochanter is rather narrow for
cannulated screw to three or four
perfect control of retinacular tension
Kirschner wires across the growth
during callus removal, and this may
plate.
explain why necrosis of the
• These procedures are minimally
epiphysis could not sufficiently be
invasive, simple to carry out, and
eliminated with this procedure.
continue to be widely used.
Source : Slipped capital femoral epiphysis: current management strategies, Orthopedic Research and Reviews
 In situ fixation

https://www.orthobullets.com/pediatrics/4040/slipped-capital-femoral-epiphysis-scfe
 SHD

Source : Slipped capital femoral epiphysis: current management strategies, Orthopedic Research and Reviews
 Prognosis

Stable SCFE > Unstable SCFE

Source : Slipped capital femoral epiphysis: current management strategies, Orthopedic Research and Reviews
Slipped Capital Femoral Epiphysis: Diagnosis and Management
 CRITICAL
APPRAISAL
 Tittle

publication year

researchers and research department

    CRITICAL  APPRAISAL  
YA (+)
No KRITERIA TIDAK
(-)
1 Jumlah kata dalam Judul < 12 kata +

2 Deskripsi  Judul  +

3 Daftar penulis sesuai aturan jurnal +

4 Korespondensi penulis +

5 Tempat dan waktu penelitian dalam judul -

  ABSTRAK  
1 Abstrak 1 paragraf  +
2 Mencakup IMRC +
3 Secara keselurah informatif  +
4 Tanpa singkatan selain baku  +
5 Kurang dari 250 kata +
(170
kata)
                  Pendahuluan    
1 Terdiri dari 2 bagian atau 2 paragraf +
2  Paragraf pertama mengemukakan alasan dilakukannya penelitian +
3 Paragraf kedua menyatakan hipotesis atau tujuan penelitian +

4 Didukung oleh pustaka yang relevan +

5 Kurang dari 1 halaman +

  Pembahasan, Kesimpulan, Daftar pustaka  

1 Pembahasan dan kesimpulan terpisah +

2 Pembahasan dan kesimpulan di paparkan dengan jelas +

3 Pembahasan mengacu pada penelitian sebelumnya  +

4 Pembahasan sesuai landasan teori +

5 Keterbatasan penelitian  -

6 Simpulan utama +

7 Simpulan berdasarkan penelitian  +

8 Saran penelitian  -

9 Penulisan daftar pustaka sesuai aturan +

 Tittle

researchers and research department

publication year
    CRITICAL  APPRAISAL  
  ABSTRAK  
YA (+)
1 Abstrak 1 paragraf  +
No KRITERIA TIDAK
(-) 2 Mencakup IMRC +
1 Jumlah kata dalam Judul < 12 kata + 3 Secara keselurah informatif  +
4 Tanpa singkatan selain baku  +
2 Deskripsi  Judul  +
5 Kurang dari 250 kata +
3 Daftar penulis sesuai aturan jurnal + (197
kata)
4 Korespondensi penulis +

5 Tempat dan waktu penelitian dalam judul -

                  Pendahuluan    
1 Terdiri dari 2 bagian atau 2 paragraf -
2  Paragraf pertama mengemukakan alasan dilakukannya penelitian -
3 Paragraf kedua menyatakan hipotesis atau tujuan penelitian -

4 Didukung oleh pustaka yang relevan +

5 Kurang dari 1 halaman +

  Pembahasan, Kesimpulan, Daftar pustaka  

1 Pembahasan dan kesimpulan terpisah +

2 Pembahasan dan kesimpulan di paparkan dengan jelas -

3 Pembahasan mengacu pada penelitian sebelumnya  +

4 Pembahasan sesuai landasan teori +

5 Keterbatasan penelitian  -

6 Simpulan utama -

7 Simpulan berdasarkan penelitian  -

8 Saran penelitian  -

9 Penulisan daftar pustaka sesuai aturan +

THANK YOU