Slipped capital femoral epiphysis in an ambulant patient with spastic cerebral palsy. A long-term evolution
DOI:
https://doi.org/10.23938/ASSN.0864Keywords:
Slipped capital femoral epiphysis (SCFE)., Cerebral palsy., In situ fixation.Abstract
We report the case of a boy aged 13 years and 9 months, with predominantly right-sided spastic tetraparesis, who could walk with assistance, GMFCS III, phenotype consistent with adiposogenital syndrome. He presented a 4-week history of left-sided limp without pain, radiologically classified as a stable, chronic slipped capital femoral epiphysis (SCFE) with mild slippage (<30º) on the Southwick classification.
In situ fixation of the hip was performed using a full-headed screw, followed by six weeks of rest. Twelve years since the intervention, the patient remains asymptomatic with no clinical or radiological changes.
SCFE in patients with cerebral palsy, while highly unusual, is possible. A high level of suspicion is required for diagnosing it. We would suggest ruling out the appearance of SCFE during surveillance screening of patients with cerebral palsy, ≥ 10 years-old, particularly in obese individuals with or without adiposogenital phenotype and limited ability to communicate verbally.
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WEINER D. Pathogenesis of slipped capital femoral epiphysis: current concepts. J Pediatr Orthop 1996; 5: 67-73. https://doi.org/10.1097/01202412-199605020-00002
CHUNG CH, KO KR, KIM JH, SHIM JS. Clinical and radiographic characteristics of atypical slipped capital femoral epiphysis. J Pediatr Orthop 2019; 39: e742-e749. https://doi.org/10.1097/bpo.0000000000001339.
KARDASHIAN G, STRONGWATER AM. Slipped capital femoral epiphysis in a cerebral palsy patient: a case report. J Pediatr Orthop B 2010; 19: 428-430. https://doi.org/10.1097/bpb.0b013e32833af50a
QUICK TJ, WILLIAMSON DM. A case of slipped upper femoral epiphysis in a nonambulant patient with cerebral palsy. J Pediatr Orthop B 2011; 20: 270-271. https://doi.org/10.1097/bpb.0b013e328344e78c
NHAMOUCHA Y, TAZI M, ABDELLAOUI H, ALAOUI O, ANDALOUSSI S, OUKHOYA M et al. Slipped capital femoral epiphysis in a patient with cerebral palsy due to seizure. Pan Afr Med J 2018; 31: 89. https://doi.org/10.11604/pamj.2018.31.89.6832
HERRING JA. Tachdjian’s Pediatric Orthopaedics. 4th ed. Philadelphia: Saunders/Elsevier, 2008.
GELBERMAN RH, COHEN MS, SHAW BA, KASSER JR, GRIFFIN PP, WILKINSON RH. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am 1986; 68: 1000-1007. https://doi.org/10.2106/00004623-198668070-00006
PRITCHETT JW, PERDUE KD. Mechanical factors in slipped capital femoral epiphysis. J Pediatr Orthop 1988; 8: 385-388. https://doi.org/10.1097/01241398-198807000-00001
MILLER F, SLOMCZYKOWSKI M, COPE R, LIPTON G. Computer modelling of the pathomechanics of spastic hip dislocation in children. J Pediatr Orthop 1999; 19: 486-492. https://doi.org/10.1097/00004694-199907000-00012
DUNCAN JW, LOWELL WW. Anterior slip of the capital femoral epiphysis. Report of a case and discussion. Clin Orthop Relat Res 1975; 110: 171-173. https://doi.org/10.1097/00003086-197507000-00022
MIRKOPOULOS N, WEINER DS, ASKEW M. The evolving slope of the proximal femoral growth plate relationship to slipped capital femoral epiphysis. J Pediatr Orthop 1988; 87: 268-273. https://doi.org/10.1097/01241398-198805000-00003
FISHKIN Z, ARMSTRONG DG, SHAH H, PATRA A, MIHALKO WM. Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. J Pediatr Orthop 2006: 26: 291-294. https://doi.org/10.1097/01.bpo.0000217730.39288.09
MILLIS MB, NOVAIS EN. In situ fixation for slipped capital femoral epiphysis. Perspectives in 2011. J Bone Joint Surg 2011; 93: 46-51. https://doi.org/10.2106/jbjs.k.00040
TOPOLESKI TA, KURTZ CA, GROGAN DP. Radiographic abnormalities and clinical symptoms associated with patella alta in ambulatory children with cerebral palsy. J Pediatr Orthop 2000; 20: 636-639. https://doi.org/10.1097/01241398-200009000-00016
SCHUR MV, ANDRAS LM, BROOM AM, BARRETT KK, BOWMAN CA, LUTHER H et al. Continuing delay in the diagnosis of slipped capital femoral epiphysis. J Pediatr 2016; 177: 250-254. doi: 10.1016/j.jpeds.2016.06.029. https://doi.org/10.1016/j.jpeds.2016.06.029
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