Slipped capital femoral epiphysis: a review of 40 consecutive cases at the National Orthopaedic Hospital Enugu

Abstract

Introduction: Slipped capital femoral epiphysis (SCFE) is not a life threatening condition. However, untreated and complicated slipped capital femoral epiphysis can lead to deformity and early osteoarthrosis of the hip. This can lead to considerable morbidity. Recent studies^1,2,3 from other centers have described diagnosis, treatment and outcome. The aim of this study therefore, is to: establish the pattern of presentation of Slipped Capital Femoral Epiphysis in our environment, analyze the treatment given and its outcome, observe the complication arising from this condition and recommend ways of improved management.

Patients and Methods: The case notes of patients who had Slipped Capital Femoral Epiphysis seen at National Orthopedic Hospital between January 1 2006 –December 2015(10years) were retrieved and analyzed

Result: There were Forty (40) Patients, Eighteen (18), Males and Twenty Two (22) Females with a Male Female ratio of 1:1.3 .The Range (in years) was 9 -16yrs (See Figure 1) with a Mean Age (M &F) of 12.9. The Mean Age for Females (F) is 12.55 years while that of Males (M) is 13.33. Eight (8) (20%) of our patients had Associated Conditions. The Average number of days before presentation was 134.2 days with a Range of 3 to 365 days .The Sides affected showed Fourteen (14)(35%) patients had the Left side affected while eighteen 18(45%) had it on the Right. Eight (8) (20%) patients had bilateral conditions. Thirteen (13)(32.5%) patients had Revision Surgery. Eleven (11)(27.5%)had Complications of the condition .

Discussion: Our patients did not show any sex preference. This is in contrast to with the findings of Kelsey⁴ which revealed a propensity of the left hip to be involved in boys as against the right in our review. Majority (20%) of our patients had bilateral condition which is in keeping with most reports in the literature.⁵

Conclusion: A retrospective review of Slipped Upper Femoral Epiphysis managed at the National Orthopaedic Hospital Enugu has been examined. Most of our patients presented late and avascular necrosis the major complication of the series. We will therefore recommend a high index of suspicion for physicians who see these patients primarily as the diagnosis is often subtle, and symptoms, such as groin or knee pain, can be misleading and also to create awareness as most of our patients presented to the Traditional Bone Setters at the early stages of the condition. We believe like Alvin⁶ postulated that early presentation will enable the surgeon intervene early and mitigate these complications.

Keywords: Slipped Capital Femoral Epiphysis, Pattern of presentation, Treatment and Outcome