Phase 5 involves ensuring adequate functional power for return to play or daily functioning. Phases 3 and 4 involve strengthening within functional movement patterns, increasing range of motion, and aerobic conditioning. Phase 2 includes discarding crutches if the patient has a normal pain-free gait and can perform straight leg raise abduction without pain. Appropriate ambulatory aids are used, and gait analysis is performed to observe the patient's heel-to-toe pattern. 37 Phase 1 focuses on reducing joint inflammation, protecting soft-tissue repair, synergistic muscle activation, and range of motion. Most physiatrists recommend a five-phase protocol with predictable recovery times. Postoperative rehabilitation protocols for SCFE are poorly described in the literature. Radiography to rule out fracture physical examination Radiography laboratory testing joint aspiration Hip radiography or magnetic resonance imaging Vague hip pain, decreased internal rotation of hip Radiography, laboratory testing, ultrasonography History of overuse radiography to rule out fractures 1, 4, 7 – 9 These patients should be evaluated with appropriate radiography.Īpophyseal avulsion fracture of the anterosuperior and anteroinferior iliac spineĪpophysitis of the anterosuperior and anteroinferior iliac spine 7, 8 SCFE should be considered in children who present with limping and vague pain in the hip, groin, thigh, or knee. 4, 6 Delays in diagnosis can lead to disabling conditions and early-onset degenerative hip arthritis that eventually require hip reconstruction. The prognosis is related to how quickly SCFE is diagnosed and treated. 4, 5 In particular, physicians should be careful not to dismiss the patient's symptoms by diagnosing an adductor muscle strain (groin pull) this is rare in an adolescent. 3 Because of various factors, physicians often miss SCFE when patients initially present with vague symptoms. 1, 2 Figure 1 illustrates developing hip anatomy. 1, 2 SCFE is defined as the posterior and inferior slippage of the proximal femoral epiphysis on the metaphysis (femoral neck), which occurs through the epiphyseal plate (growth plate). Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents, usually occurring between eight and 15 years of age. Postoperative rehabilitation of patients with SCFE may follow a five-phase protocol. Treatment of unstable SCFE also usually involves in situ fixation, but there is controversy about timing of surgery and the value of reduction. Stable SCFE is usually treated using in situ screw fixation. The goals of treatment are to prevent slip progression and avoid complications such as avascular necrosis, chondrolysis, and femoroacetabular impingement. Diagnosis is confirmed by bilateral hip radiography, which should include anteroposterior and frog-leg views in patients with stable SCFE, and anteroposterior and cross-table lateral views in unstable SCFE. Patients with SCFE usually present with limping and poorly localized pain in the hip, groin, thigh, or knee. It is associated with obesity, growth spurts, and (occasionally) endocrine abnormalities such as hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism. SCFE is classified as stable or unstable based on the stability of the physis. SCFE usually occurs in those eight to 15 years of age and is one of the most commonly missed diagnoses in children. Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents, occurring in 10.8 per 100,000 children.
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