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Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (coxa vera) is, as the name implies, a slipping of the femur head in relation to the neck of the femur at the epiphyseal line.

Slipped capital femoral epiphysis (coxa vera) is, as the name implies, a slipping of the femur head in relation to the neck of the femur at the epiphyseal line. The proximal femoral head displaces posteriorly and inferiorly. The cartilage covering the femur head may be destroyed by necrosis, resulting in permanent loss of motion of the femoral head. An avascular necrosis similar to Legg-Calvé-Perthes disease may occur. With both complications, surgical reconstruction of the hip joint will be necessary.

This disorder occurs most frequently in preadolescence. It is twice as frequent in African Americans as other races and twice as frequent in boys as in girls. It is more common in obese or rapidly growing children. This suggests that it occurs due to the influence of growth hormone and excessive weight bearing in the preadolescent child.

The onset of symptoms is gradual. On inspection, children often will be observed limping and holding their leg externally rotated to relieve stress and pain in the hip joint. They report pain first in their knees, because favoring the hip joint puts abdominal stress on the knee. On physical examination, internal rotation of the hip is difficult and painful. X-ray will reveal the slipped epiphysis at the femoral head.

Early detection is important because correction is easiest if it attempted before the condition has progressed to epiphyseal destruction. Surgery with pinning or external fixation, such as with skeletal traction, is used to stabilize the femur head. After the surgery, the child may have activity restrictions or be confined to bed. Because it is most common in preadolescence, these children need continued support. Help them to understand the potential seriousness of the condition. Although they may not like being restricted or confined in this way, supportive communication and education can help them accept this as necessary to maintain good healing and function of the hip joint. Encourage frequent visits and telephone calls with friends to provide optimal growth and development.

Although this condition usually is unilateral, a number of affected children later develop the same condition in the opposite hip. All children with a slipped epiphysis, therefore, need follow-up care, with careful attention to the condition of the opposite hip.

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