Slipped capital femoral epiphysis

Nguyen, A. R.; Ling, John; Gomes, Bárbara Leticia Corrêa; Antoniou, Georgia; Sutherland, Leanne M.; Cundy, Peter

doi:10.1302/0301-620x.93b10.26852

Cited by 38 publications

(10 citation statements)

References 21 publications

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“…The concerns regarding the rising incidence of SCFE relative to the increasing prevalence of obesity in children (Neovius et al 2006, Nguyen et al 2011 are not supported by this study. As a matter of fact, the incidence rate has some variation since 1978, with peaks in 1981 and 2002, but it then remains roughly the same until 2011.…”

Section: Discussioncontrasting

confidence: 59%

Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

Hailer

2020

Acta Orthopaedica

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Background and purpose — Associations between obesity and slipped capital femoral epiphysis (SCFE) during adolescence are described; however, few studies report on the lifetime risk of obesity in patients with SCFE. In addition, with the obesity epidemic in children and adolescents, an increasing incidence of SCFE might be expected. An association of SCFE with hypothyroidism seems ambiguous, and the association between SCFE and depression and all-cause mortality has not yet been evaluated. This study investigates the associations of SCFE with obesity, hypothyroidism, depression, and mortality, and putative changes in the yearly incidence of SCFE. Patients and methods — 2,564 patients diagnosed with SCFE at age 5–16 diagnosed between 1964 and 2011 were identified in the Swedish Patient Register. These were matched for age, sex, and residency with unexposed control individuals. Cox regression models were fitted to estimate the risk of obesity, hypothyroidism, depression, and death, in exposed compared with unexposed individuals. Results — The risk of obesity (HR 9, 95% CI 7–11) and hypothyroidism (HR 3, CI 2–4) was higher in SCFE patients compared with controls. There was no increase in the risk of developing depression (HR 1, CI 1–1.3) in SCFE patients. In contrast, all-cause mortality was higher in SCFE patients than in controls (HR 2, CI 1–2). The incidence of SCFE did not increase over the past decades. Interpretation — Patients with SCFE have a higher lifetime risk of obesity and hypothyroidism and a higher risk of all-cause mortality compared with individuals without SCFE. These findings highlight the lifetime comorbidity burden of patients who develop SCFE in childhood, and increased surveillance of patients with a history of SCFE may be warranted. The incidence of SCFE did not increase over the last decades despite increasing obesity rates.

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Section: Discussioncontrasting

confidence: 59%

Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

Hailer

2020

Acta Orthopaedica

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“…This supports the finding of one previous small study (n=26) that found early BMI abnormalities in children prior to the diagnosis of SCFE, 16 and several larger series from specialist centres that report strong associations with obesity among children affected by SCFE. 12 14 15 However, only 174 children had a BMI recorded within their medical records prior to diagnosis, which may introduce a selection bias. Such individuals may have had their BMI recorded owing to a particular concern (eg, obesity), which may therefore misrepresent the cohort.…”

Section: Discussionmentioning

confidence: 99%

A nationwide cohort study of slipped capital femoral epiphysis

et al. 2017

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ObjectivesTo describe the epidemiology of slipped capital femoral epiphysis (SCFE), to examine associations with childhood obesity and socioeconomic deprivation, and to explore factors associated with diagnostic delays.DesignHistoric cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics.SettingAll contacts with healthcare services, including emergency presentations, outpatient appointments, inpatient admissions and primary care visits, within the UK National Health Service.PatientsAll individuals <16 years old with a diagnosis of SCFE and whose electronic medical record was held by one of 650 primary care practices in the UK between 1990 and 2013.Main outcome measuresAnnual incidence, missed opportunities for diagnosis and diagnostic delay.ResultsOver the 23-year period the incidence remained constant at 4.8 (95% CI 4.4 to 5.2) cases per 100,000 0–16-year-olds. There was a strong association with socioeconomic deprivation. Predisease obesity was also strongly associated with SCFE; mean predisease z-score of body mass index was 1.43 (95% CI 1.20 to 1.68) compared with the UK reference mean. Diagnostic delays were common, with most children (75.4%) having multiple primary care contacts with relevant symptomatology, and those who presented with knee pain having significantly longer diagnostic delay (median 161 (IQR 27–278) days) than those with hip pain (20 (5–126)) or gait abnormalities (21 (7–72)).ConclusionsSCFE has a strong association with both area-level socioeconomic deprivation and predisease obesity. The majority of patients with SCFE are initially misdiagnosed and those presenting with knee pain are particularly at risk.

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“…This includes patients who have Vitamin D deficiency and are of Aboriginal Australian descent. 17,18 Additionally, Shank et al have shown that coxa valga is a risk factor for valgus slips. 4 When they do occur, it is more common on the left hip.…”

Section: Discussionmentioning

confidence: 99%

Capital Femoral Epiphysis with Acute Unstable Valgus Type Slip Managed with Closed Reduction and Percutaneous Fixation: A Case Report

Cheok,

Jennings,

Berman

et al. 2023

ORR

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We present a case of acute unstable valgus slipped capital femoral epiphysis (SCFE) in an 8-year-old female who presented after a trip and fall. The patient was managed with emergent closed reduction and percutaneous screw fixation and prophylactic fixation of contralateral side after 6 weeks. At 18-month follow-up, the patient was symptom free with a good range of movement and no evidence of slip progression, chondrolysis or avascular necrosis of the femoral head. Conclusion:We demonstrate that, in this case, closed reduction and percutaneous fixation provided satisfactory outcome at 18-month follow-up. This case highlights the need for both anteroposterior and lateral radiographs.

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Slipped capital femoral epiphysis

Cited by 38 publications

References 21 publications

Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

A nationwide cohort study of slipped capital femoral epiphysis

Capital Femoral Epiphysis with Acute Unstable Valgus Type Slip Managed with Closed Reduction and Percutaneous Fixation: A Case Report

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