Fact-sheet: Epiphysiolysis of femoral head


Updated on 10/02/2020 at 4:58 PM

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Definition

Slipped capital femoral epiphysis preferentially affects adolescents, with a marked male predominance.

It represents a Salter I fracture equivalent resulting in posteroinferior displacement of the femoral metaphysis, while the femoral head remains in place within the acetabulum.

Diagnostic and therapeutic emergency due to the risk of femoral head necrosis and chondrolysis leading to early osteoarthritis.

Clinical features

Predisposing factors:

  • peripubertal period
  • obesity
  • decreased femoral anteversion
  • Black population

Radiography

  • The lateral view is the most relevant: analyze the posteromedial tilt of the epiphyseal nucleus
  • Increased basicervical angle (flèche basicapitale).
  • Decreased coverage of the neck and ischium (Capener's triangle)
  • On the AP view, drawing Klein's line, which no longer intersects the head = slippage, but of low sensitivity
  • Malalignment between the neck and the head, with the axis of the neck no longer perpendicular to the growth plate.

MRI

Limited role, reserved for radiographically and clinically equivocal cases:
look for bone marrow edema on the medial aspect of the metaphysis, and early slippage

Management

  • Non-weight bearing.
    Surgery.