UNASSIGNED: Hip pain in children is common, with causes ranging from the benign to destructive. This article reviews slipped capital femoral epiphysis (SCFE), one of the most common hip pathologies in preadolescents and adolescents, which often is missed or delayed in diagnosis because of its vague, atypical presentation.

Slipped Capital Femoral Epiphysis (SCFE) is a physeal disorder of the proximal femur. Misdiagnosis and late treatment are associated with poorer outcomes. The epidemiology and delays in treatment of the disease between 1968 and 2018 were investigated in North Trinidad. The number of cases presenting annually has increased over the decades and the incidence between 2008-2018 was 2.2 cases per 100 000 per year. Almost 70% of cases were above the 95th percentile for body weight. Delay in treatment from onset of symptoms was 278 ± 258 days. Awareness of the risk factors and clinical presentation of SCFE may facilitate early diagnosis and treatment, and prevent severe hip disability in adulthood.

BACKGROUND: Treatment of SCFE is still controversial, especially in moderate and severe forms. Dunn osteotomy performed with the Ganz approach became very popular in the last decade, although it is a complicated and challenging surgical procedure with a risk of AVN. The aim of our study was to analyze the current literature verifying the effectiveness of this surgical procedure, with specific attention to the incidence of AVN and other complications.
METHODS: A systematic review on the subject was performed according to the PRISMA guidelines. A literature search was performed by searching all published articles about the topic in the databases. The articles were screened for the presence of the following inclusion criteria: patients affected by slipped capital femoral epiphysis (SCFE) surgically treated by Dunn osteotomy using the Ganz surgical approach. All the patients affected by pathologies other than SCFE, treated without surgery or with procedures not including a surgical hip dislocation were excluded. Based on inclusion and exclusion criteria, 23 studies were included in our systematic review. Selected articles were published from 2009 to 2021 and they included 636 overall hips. According to the selected articles, Dunn osteotomy modified by Ganz, performed by an experienced surgeon, allows for anatomical reduction of moderate or severe SCFE with a low incidence of AVN.
CONCLUSIONS: The few papers with long term follow-up, reported no progression of hip osteoarthritis, however, since the patients are adolescent at surgery, longer follow-up studies are needed to validate this statement. It is still debated if better results are obtained in stable or unstable SCFE. The indication of this procedure in mild SCFE remains controversial.
METHODS: 3.

Slipped capital femoral epiphysis (SCFE) has a well-documented association with underlying endocrine conditions, including thyroid hormone aberrations and parathyroid dysfunction.
Recombinant growth hormone therapy has also been identified as a risk factor for the development of SCFE.
Presentation before their 10th birthday or after their 16th birthday along with height of <10th percentile are reliable risk factors for identifying children with an SCFE who are at a heightened risk for an underlying endocrinopathy and can been used to guide selective laboratory testing.
Patients with unilateral SCFE presentations with an underlying endocrinopathy are at a heightened risk for contralateral slip development and should be treated with prophylactic fixation.

BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a common disease in pediatric orthopedics. Most research on SCFE has focused on high-risk groups or the whole population, and studies focusing on adult SCFE patients are rare. In the present study, we report the case of an adult patient with SCFE.
METHODS: A 37-year-old man presented to our clinic with persistent pain that was poorly localized to both hips, groin regions, and thighs for more than 1 year.
METHODS: A bilateral hip X-ray examination was performed, and the femoral epiphyses were found to be unfused on both sides. Low levels of growth hormone (GH), insulin-like growth factor-1 (IGF-1), triiodothyronine (T3), thyroxine (T4), follicle-stimulating hormone, luteinizing hormone, estradiol, and testosterone, and high levels of thyroid-stimulating hormone, prolactin, and cortisol.
METHODS: Hormone-substitution therapies (levothyroxine sodium to treat hypothyroidism and testosterone enanthate to treat hypogonadism) were prescribed. Total hip arthroplasty was performed to treat femoral epiphysis slippage.
RESULTS: After 6 months of postoperative follow-up, the patient\'s gait improved significantly, and bilateral hip pain was relieved.
CONCLUSIONS: When treating adults with SCFE, clinicians must be alert to endocrine disorders. Comprehensive imaging evaluation is crucial for the accurate diagnosis and selection of an appropriate treatment.

An unstable slipped capital femoral epiphysis (SCFE) is characterized by the inability to walk and is associated with a high risk of osteonecrosis.
An unstable SCFE is less common than a stable SCFE; however, the demographics are similar in both groups of patients with SCFE.
The diagnosis of an unstable SCFE is characterized by a history of antecedent pain and the inability to walk on examination, and it is confirmed by radiographic assessment.
Management of an unstable SCFE includes closed reduction, open reduction, and capital realignment, which have all been noted to have lower rates of osteonecrosis than reported in historic reports.
All management approaches have certain advantages and disadvantages, and comparative studies are needed to guide clinical decision-making.

To determine the efficacy of arthroscopic osteochondroplasty for patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE).
A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Embase, PubMed (Medline), and Cochrane Library up to November 1, 2019. Data including patient demographics, slip severity according to Southwick, outcomes, and complications were retrieved from eligible studies that reported a minimum 3-month follow-up of arthroscopic osteochondroplasty for FAI secondary to SCFE. Methodological Index for Non-Randomized Studies (MINORS) criteria was used to assess quality of studies. Heterogeneity and quality were evaluated using P values and the I2 statistic.
Six studies (90 hips) were analyzed. The range of MINORS scores was 8 to 11. Most studies were level of evidence 4 (n = 4, 66.7%), with more men than women (n = 5, 83.3%). The ranges of age, body mass index, and follow-up length after surgery were 10 to 42 years, 17.5 to 32.3 kg/m2, and 3 to 56 months, respectively. The Modified Harris Hip Score (mHHS) was the most commonly used score to report on clinical outcomes (n = 2 studies, 28 hips) with a significant improvement following surgery. Three studies reported an improvement in internal rotation (IR) of the hip with a range of improvement of 17° to 32°, with low heterogeneity (I2 = 0% and P = .531). Five studies reported a significant correction of the α angle, with range of improvement of 19.9° to 37.3°. The range of postoperative α angle was 32° to 67°, and 3 studies achieved appropriate postoperative α angle (40° to 50°), with low heterogeneity (I2 = 8.4% and P = .336). The total number of complications was 8 (1 major complication) and there were 6 revisions, with low heterogeneity.
Arthroscopic osteochondroplasty for FAI secondary to SCFE provides good short- to medium-term outcomes and improves IR of the hip, with the ability to potentially correct the α angle with a low rate of complications and revision.
IV, systematic review of level II to IV studies.

Valgus slipped capital femoral epiphysis (SCFE) is a rare entity which leads to a proximolateral displacement of the hip epiphysis. The literature on valgus SCFE consists of case reports or case series. Since no evidence synthesis has been conducted, a systematic review on all published cases of valgus SCFE was conducted. The search strategy located 27 studies comprising 74 subjects with 96 hips. Demographic results were as follows: female/male ratio was of 1.65, and the mean age at presentation was 13.0 ± 2.54 years. Bilateral cases were recorded in 31.1%. Hip pain was the most frequent symptom followed by limping. The most frequent clinical sign was the limitation of medial internal rotation. Comorbidities were present in 65.6% of patients, mostly as endocrine or metabolic disorders. The mean neck-shaft angle was 149.2 ± 9.2°, the mean physis-shaft angle was 83.3 ± 9.7°, the neck-physis angle was 36.1 ± 21.5°, and the posterior physeal tilt angle was 23 ± 6.07°. The physeal tilt was lateral in 90% of cases. Treatment was based on screws in 70.8% of cases, a femoral osteotomy in 18.75%, and the remaining had a combination of surgical procedures. Two out of the three screw migrations occurred following fixation with more than one screw. All major complications (8.3%) had the potential of developing osteoarthritis in the future. Valgus SCFE entity demonstrates distinctive demographic, clinical and radiological results. This rare entity should be always included in the differential diagnosis of hip pain or limping in children.

BACKGROUND: The New Zealand Māori and Pacific ethnicities have the highest burden of slipped capital femoral epiphysis (SCFE) worldwide. Therefore, New Zealand provides a rich and unique therapeutic and research environment for this devastating hip condition.
METHODS: A systematic literature review was performed using MEDLINE, PubMed, and Google Scholar from January 1, 1900, to December 31, 2019, with the following keywords: New Zealand, SCFE, slipped capital femoral epiphysis, SUFE, and slipped upper femoral epiphysis. The references were also screened.
RESULTS: Eight original scientific research articles that had been published in peer-reviewed journals were identified, as well as 4 published abstracts from conference proceedings; we summarized the key findings. The New Zealand Māori and Pacific ethnicities have the highest reported burden of SCFE, with 4.2 and 5.6 times the prevalence, respectively, when compared with New Zealand European (Caucasian). Māori children are younger at presentation (p = 0.002) and more frequently present with bilateral SCFE (p = 0.05), and there is a strong link with childhood obesity. A contralateral posterior sloping angle (PSA) of ≥14° may be used as an adjunct threshold for decision-making regarding prophylactic pinning. A PSA of ≥40° was found to correlate with a higher likelihood of unsatisfactory functional outcome following SCFE pinning in situ. When conversion to total hip arthroplasty is eventually required due to SCFE, early functional outcomes are similar to those of patients with primary osteoarthritis, and revision rates and mortality rates are not significantly different.
CONCLUSIONS: Landmark literature from New Zealand has been published on SCFE management, and there is a promising future of quality, impactful research.
METHODS: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Congenital, developmental, and acquired conditions of the pediatric hip frequently present with sequelae in the adult. There is substantial overlap in the end-stage results of these pathologic conditions, including osseous changes, chondral/labral injuries, and premature osteoarthritis. This review discusses the top 10 etiopathogeneses of pediatric hip conditions and presents associated dysmorphisms in the adult on an illustrative, multimodality, case-based template. Quantitative imaging metrics and the role of advanced imaging techniques are reviewed. The ultimate goal is enhanced understanding of the expected evolution of childhood hip pathologic conditions and their associated complications for general radiologists.