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Bouchard MD, Vescio BG, Munir M, Gilbert J, de Souza RJ, Kay J, de Sa D, Wahi G. The Epidemiology of Slipped Capital Femoral Epiphysis in Children and Adolescents: A Systematic Review of Risk Factors and Incidence Across Populations. JBJS Rev 2025; 13:01874474-202505000-00004. [PMID: 40403127 DOI: 10.2106/jbjs.rvw.25.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2025]
Abstract
BACKGROUND Childhood obesity is a growing global health crisis with significant health and orthopedic complications such as slipped capital femoral epiphysis (SCFE), a hip disorder characterized by the displacement of the metaphysis relative to the epiphysis. SCFE always requires surgical intervention to prevent severe outcomes such as avascular necrosis, gait abnormalities, and lifelong disability and deformity. Obesity is a well-established risk factor for SCFE; however, emerging evidence suggests that elevated leptin levels may independently contribute to the development of SCFE, regardless of obesity status. This systematic review synthesizes geographic, socioeconomic, age, and sex-related trends in SCFE incidence among children with obesity. METHODS Searches of Embase, OVID Medline, and Emcare databases were performed from inception through October 1, 2024. Observational studies reporting the incidence of SCFE in children and adolescents with obesity (aged ≤18 years) across various geographic populations were included. Studies involving children with other chronic health conditions or animal studies on the physis were excluded. Study quality was evaluated using the methodological index for nonrandomized studies scoring system. Descriptive statistics were presented as absolute frequencies with percentages or as weighted means with corresponding measures of variance where applicable. RESULTS Fifteen studies (5,467 patients) from North America, Europe, Asia, and Oceania met inclusion criteria. SCFE patient samples ranged from 55 to 1,630, with some larger cohorts monitoring multiple medical conditions. The mean age was 12.0 years (SD = 0.4), and male-to-female ratios ranged from 1.43:1 to 3.12:1. SCFE incidence varied by region, from 50.5 per 100,000 (Sweden) to 0.33 per 100,000 (South Korea), with a pooled incidence of 9.62 per 100,000. Overweight prevalence was highest in Sweden (66%) and South Korea (67.6%) and lowest in Japan (11.8%). Unilateral SCFE predominated (68.4% to 90.6%). In situ screw fixation was the most common treatment, with 1 study reporting intertrochanteric osteotomy. CONCLUSION Geographic variation in SCFE incidence suggests multifactorial influences beyond obesity, including socioeconomic factors, healthcare access, and genetic predisposition. Limited high-quality comparative studies and inconsistent BMI criteria highlight the need for further research to clarify SCFE risk factors. LEVEL OF EVIDENCE Level IV, systematic review. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Bianca G Vescio
- School of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mehnaz Munir
- School of Global Health and Social Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Justin Gilbert
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- School of Global Health and Social Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Gita Wahi
- School of Global Health and Social Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Khalifa A. Fix it or risk it? Revisiting contralateral hip prophylactic fixation in unilateral slipped capital femoral epiphysis: an updated review of the past decade's literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:84. [PMID: 40025359 DOI: 10.1007/s00590-025-04191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 02/02/2025] [Indexed: 03/04/2025]
Abstract
Slipped capital femoral epiphysis (SCFE) is a common hip pathology occurring in pediatrics and adolescents, and its management is well documented in the literature regardless of its severity. In patients presenting with unilateral SCFE, the incidence of subsequent contralateral slip (SCS) is variable among studies, and the issue of contralateral hip prophylactic fixation (CHPF) becomes a concern. The fundamental rationale behind performing CHPF is to avoid the subsequent contralateral slip, which consequently lowers the risk of femoral head avascular necrosis and chondrolysis. However, prophylactic fixation carries the risk of altering proximal femoral growth, peri-implant fractures, and requiring secondary surgery for hardware removal. The current review was formulated based on the literature published in the last decade and aimed to evaluate the incidence of SCS and indications for CHPF. Apart from institutions' protocol or individual surgeons' preferences, various variables were suggested to justify CHPF, including patient-related variables such as the presence of endocrinopathy, those younger than 13 years old (10-13), and patients with mOBAS ≤ 20. Radiological parameters, posterior slip angle ≥ 14.5°, positive crossover sign, posterior epiphyseal tilt of ≥ 10°, alpha angle of ≥ 49°, and a Probability analysis of sequential SCFE (PASS score) of ≥ 3. However, there is still a controversy in the literature regarding CHPF performance and which parameter is highly dependable for predicting the SCS. The controversy extends to the effect and efficacy of various fixation hardware and whether keeping patients under observation is less effective than CHPF. Furthermore, well-designed randomized controlled trials are lacking, and their performance is warranted to establish clear indications for performing CHPF and to clarify its safety, possible consequences, and cost-effectiveness.
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Affiliation(s)
- Ahmed Khalifa
- Orthopedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
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Maatough A, Leonard M, Elbardesy H, Kutty S. Slipped Upper Femoral Epiphysis in Adolescents: Evolving Information on Its Mode of Presentation and Management. Cureus 2023; 15:e37674. [PMID: 37206525 PMCID: PMC10189661 DOI: 10.7759/cureus.37674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background and objective Slipped upper femoral epiphysis (SUFE) is one of the most common hip pathologies in adolescents and pre-adolescents, the diagnosis of which is often missed due to delayed presentations. In this study, we aimed to conduct a retrospective analysis of SUFE cases treated in the hospital during the 15-year period from 2003 to 2018 and examine its bilateral presentation and the need for prophylactic pinning on the unaffected side. Methods This retrospective cohort study involved cases that were treated from 2003 to 2018. The case details were retrieved from the medical records department. Records older than 15 years were excluded owing to their inaccuracy, and 26 cases of SUFE were included in the final analysis. Each case was subjected to physical and radiological examinations of the symptomatic and asymptomatic hips. IBM SPSS Statistics v23 (IBM Corp., Armonk, NY) was used for data analysis. Results In this study, six of the 26 patients had bilateral SUFE and required subsequent surgical pinning. The duration of surgical interventions ranged from two to 22 months, while the mean intervention duration was 10.3 months. Among the cases, 61.5% (p<0.05) were idiopathic in nature upon documentation. However, 19% (p<0.05) of the cases were shown to be associated with an underlying condition or prior symptoms of the condition, whereas 7.6% (p<0.05) had an increased basal metabolic index; 11% (p<0.05) of the cases had an inherited family history of SUFE. A comparison between males and females showed a slightly higher frequency of complications in males (n=14) than in females (n=12) (p=0.556). The age of the patients at the presentation ranged between and 10-15 years, with an average age of 12.5 years. Conclusion Based on our findings, males were affected more than females and most of the cases were idiopathic. There is no significant evidence to support the need for prophylactic pinning of the unaffected hip. We recommend prospective studies with a larger sample of patients to gain more insight into the topic.
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Affiliation(s)
- Annis Maatough
- Trauma and Orthopaedics, Sligo University Hospital, Sligo, IRL
| | - Meave Leonard
- Trauma and Orthopaedics, Sligo University Hospital, Sligo, IRL
| | - Hany Elbardesy
- Trauma and Orthopaedics, East Kent University Hospitals NHS Foundation Trust, Kent, GBR
| | - Satish Kutty
- Trauma and Orthopaedics, Sligo University Hospital, Sligo, IRL
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Vink SJC, van Stralen RA, Moerman S, van Bergen CJA. Prophylactic fixation of the unaffected contralateral side in children with slipped capital femoral epiphysis seems favorable: A systematic review. World J Orthop 2022; 13:515-527. [PMID: 35633749 PMCID: PMC9124999 DOI: 10.5312/wjo.v13.i5.515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) occurs in adolescents and has an incidence of around 10 per 100000 children. Children presenting with a unilateral SCFE are 2335 times more likely to develop a contralateral SCFE than the general population. Prognostic factors that have been suggested to increase the risk of contralateral slip include a younger patient, an underlying endocrine disorder, growth hormone use and a higher radiographic posterior sloping angle. However, there is still much debate on the advantages and disadvantages of prophylactic fixation of the unaffected side in an otherwise healthy patient. AIM To investigate the risk rate of contralateral SCFE and assess the (dis)advantages of prophylactic fixation of the contralateral hip. METHODS A systematic literature search was performed in the Embase, Medline, Web of Science Core Collection and Cochrane databases. Search terms included 'slipped capital femoral epiphysis,' 'fixation,' 'contralateral,' and derivatives. The eligibility of the acquired articles was independently assessed by the authors and additional relevant articles were included through cross-referencing. Publications were considered eligible for inclusion if they presented data about otherwise healthy children with primarily unilateral SCFE and the outcomes of prophylactically pinning their unaffected side, or about the rates of contralateral slips and complications thereof. The study quality of the included articles was assessed independently by the authors by means of the methodological index for non-randomized studies criteria. RESULTS Of 293 identified unique publications, we included 26 studies with a total of 12897 patients. 1762 patients (14%) developed a subsequent symptomatic contralateral slip. In addition, 38% of patients developed a subsequent slip on the contralateral side without experiencing clinical symptoms. The most outspoken advantage of prophylactic fixation of the contralateral hip in the literature is prevention of an (asymptomatic) slip, thus reducing the increased risk of avascular necrosis (AVN), cam morphology and osteoarthritis. Disadvantages include an increased risk of infection, AVN, peri-implant fractures, loss of fixation as well as migration of hardware and morphologic changes as a consequence of growth guidance. These risks, however, appeared to only occur incidentally and were usually mild compared to the risks involved with an actual SCFE. CONCLUSION The advantages of prophylactic pinning of the unaffected side in otherwise healthy patients with unilateral SCFE seem to outweigh the disadvantages. The final decision for treatment remains to be patient-tailored.
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Affiliation(s)
- Steven J C Vink
- Department of Orthopedic Surgery, Erasmus Medical Center, Rotterdam 3015GD, Netherlands
| | - Renée A van Stralen
- Department of Orthopedic Surgery, Erasmus Medical Center, Rotterdam 3015GD, Netherlands
| | - Sophie Moerman
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen 9713GZ, Netherlands
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Jardaly A, Torrez TW, McGwin G, Gilbert SR. Comparing complications of outpatient management of slipped capital femoral epiphysis and Blount’s disease: A database study. World J Orthop 2022; 13:373-380. [PMID: 35582157 PMCID: PMC9048495 DOI: 10.5312/wjo.v13.i4.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/10/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting. Two recent examples include slipped capital femoral epiphysis (SCFE) and Blount’s disease. Surgical indications are well-studied for each pathology, but to our knowledge, there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition. We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.
AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.
METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics, rates of complications, and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.
RESULTS Total 1788 SCFE database entries were included, 30% were performed in an outpatient setting. In situ pinning was used in 98.5% of outpatient surgeries and 87.8% of inpatient surgeries (P < 0.0001). Inpatients had a greater percent of total complications than outpatients 2.57% and 1.65% respectively. Regarding Blount’s disease, outpatient surgeries constituted 41.2% of the 189 procedures included in our study. The majority of inpatients were treated with a tibial osteotomy, while the majority of outpatients had a physeal arrest (P < 0.0001). Complications were encountered in 7.4% of patients, with superficial surgical site infections and wound dehiscence being the most common. 1.6% of patients had a readmission. No differences in complication and readmission risks were found between inpatients and outpatients.
CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting. This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions. Osteotomies are more commonly performed in an inpatient setting where monitoring is available.
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Affiliation(s)
- Achraf Jardaly
- Department of Orthopaedics, Hughston Foundation/Hughston Clinic, Columbus, GA 31909, United States
| | - Timothy W Torrez
- Department of Orthopedics, University of Alabama, Birmingham, AL 35205, United States
| | - Gerald McGwin
- Department of Epidemiology, Center of Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL 35205, United States
| | - Shawn R Gilbert
- Department of Pediatric Orthopaedics, University of Alabama at Birmingham, Birmingham, AL 35233, United States
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