Delay in Diagnosis of Slipped Capital Femoral Epiphysis

Kocher, Mininder S.; Bishop, Julius A.; Weed, Bryce; Hresko, M. Timothy; Millis, Michael B.; Kim, Young Jo; Kasser, James R.

doi:10.1542/peds.113.4.e322

Cited by 141 publications

(118 citation statements)

References 22 publications

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“…In this case series, the slip angle also was not correlated with acetabular and labral injury severity. Joint damage at the time of presentation could be explained by an average 8-week delay in diagnosis reported in a review of 196 patients by Kocher et al 19 Most patients with unstable SCFEs (88%) have antecedent pain lasting on average 42 days before presentation. 20 These delays suggest that joint damage from impingement may be ongoing before the SCFE diagnosis and treatment and presumably continues as long as deformity persists.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Treatment of Mild to Moderate Deformity After Slipped Capital Femoral Epiphysis: Intra-operative Findings and Functional Outcomes

Wylie

Beckmann

Maak

et al. 2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Treatment of Mild to Moderate Deformity After Slipped Capital Femoral Epiphysis: Intra-operative Findings and Functional Outcomes

Wylie

Beckmann

Maak

et al. 2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The main predictive factors for degree of stable SCFE are age at diagnosis and symptom duration [36,51]. The most worrisome complication of treatment is AVN of the femoral head, which is strongly associated with SCFE instability [50,65,66,84].…”

Section: Search Strategies and Criteriamentioning

confidence: 99%

“…Once SCFE is diagnosed in one hip, prophylactic treatment of the contralateral hip should be considered strongly because of the high prevalence of bilateral SCFE. Although prophylactic pinning of the contralateral hip is still controversial [18,36,49], young age at diagnosis, unstable SCFE, endocrine disorders, and unreliable patient followup are relative indications for prophylactic treatment [49]. The increasing incidence of SCFE and childhood obesity [8,61,63] reinforces the necessity for promoting population-level health policies to support childhood obesity prevention [56].…”

Section: How Do We Get There?mentioning

confidence: 99%

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Novais

Millis

2012

Clinical Orthopaedics &Amp; Related Research

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133

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Background Obesity is a risk factor for developing slipped capital femoral epiphysis (SCFE). The long-term outcome after SCFE treatment depends on the severity of residual hip deformity and the occurrence of complications, mainly avascular necrosis (AVN). Femoroacetabular impingement (FAI) is associated with SCFE-related deformity and dysfunction in both short and long term. Questions/Purposes We examined obesity prevention, early diagnosis, reducing AVN and hip deformity as strategies to reduce SCFE prevalence, and the long-term outcomes after treatment. Methods A search of the literature using the PubMed database for the key concepts SCFE and treatment, natural history, obesity, and prevalence identified 218, 15, 26, and 49 abstracts, respectively. Where Are We Now? A correlation between rising childhood obesity and increasing incidence of SCFE has been recently reported. Residual abnormal morphology of the proximal femur is currently believed to be the mechanical cause of FAI and early articular cartilage damage in SCFE. Where Do We Need to Go? Reducing the increasing prevalence rate of SCFE is important. Treatment of SCFE should aim to reduce AVN rates and residual deformities that lead to FAI to improve the long-term functional and clinical outcomes. How Do We Get There? Implementing public health policies to reduce childhood obesity should allow for SCFE prevalence to drop. Clinical trials will evaluate whether restoring the femoral head-neck offset to avoid FAI along with SCFE fixation allows for cartilage damage prevention and lower rates of osteoarthritis. The recently described surgical hip dislocation approach is a promising technique that allows anatomic reduction with potential lower AVN rates in the treatment of SCFE.

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“…For example, Schur et al reported that of 481 patients diagnosed with slipped capital femoral epiphysis; time to diagnosis was delayed by a mean of 4 weeks if evaluated by a primary care physician and delayed 6 weeks if evaluated by an emergency department physician [17]. This delay in care for SCFE is similar to the data that Kocher reported in 2004 [18].…”

Section: Introductionmentioning

confidence: 53%