We report a case of slipped capital femoral epiphysis (SCFE), an on target skeletal toxicity of a pan-FGFR TKI inhibitor, erdafitinib. A 13-year-old boy was diagnosed to have an optic pathway/hypothalamic glioma with signs of increased intracranial pressure and obstructive hydrocephalus requiring placement of ventriculo-peritoneal (VP) shunt. Sequencing of the tumor showed FGFR1-tyrosine kinase domain internal tandem duplication (FGFR1-KD-ITD). He developed hypothalamic obesity with rapid weight gain and BMI >30. At 12 weeks of treatment with erdafitinib, he developed persistent knee pain. X-ray of the right hip showed SCFE. Erdafitinib was discontinued, and he underwent surgical pinning of the right hip. MRI at discontinuation of erdafitinib showed a 30% decrease in the size of the tumor, which has remained stable at 6 months follow-up. Our experience and literature review suggest that pediatric patients who are treated with pan-FGFR TKIs should be regularly monitored for skeletal side effects.

Avascular necrosis, a serious slipped capital femoral epiphysis (SCFE) complication, is difficult to treat. We report a rare case of revascularization of the necrotic femoral head in a 12-year-old male patient with a severe SCFE (posterior tilting angle, 87°). We performed the modified Dunn procedure (MDP), followed by long-term unloading therapy. Blood flow to the epiphysis had partially resumed 2.3 years postoperatively. At the final 4.5-year follow-up, blood flow had been restored, leading to epiphyseal closure without significant femoral head deformity or hip pain. The patient could walk unassisted, with a flexion range of 120°. These findings support the use of the MDP with long-term unloading therapy as a potential treatment option for severe SCFE.

This study presents a rare case of unilateral slipped capital femoral epiphysis treated surgically in a 5-year-old boy with cerebral palsy who was born at 27 weeks\' gestation and developed grade III intraventricular haemorrhage and periventricular leucomalacia and was on antiepileptic drugs, including valproic acid and levetiracetam for >3 years. The patient had no history of endocrine, renal, and significant familial diseases.

The incidence of Slipped capital femoral epiphysis (SCFE) after management of femoral neck fracture in pediatrics is very rare. In this case report, a nine-year-old female child sustained left sided femur neck fracture after a motor car accident. The fracture was fixed by two cannulated screws and healing with mild varus occurred after six weeks. However, progressive slippage of femoral epiphysis was observed. This was treated by subtrochanteric valgus osteotomy and fixed by tension band and Wagner technique. Better radiological and functional outcomes were obtained at the short term follow up.

UNASSIGNED: Atypical and subacute presentations of pediatric bacterial septic arthritis are difficult to diagnose due to lack of systemic manifestations and inadequate laboratory data. Furthermore, they may mimic certain well-documented pediatric disorders to confound the diagnosis and management.
UNASSIGNED: The authors present a case of an adolescent obese male with features suggestive of a slipped capital femoral epiphysis (SCFE). Further investigations revealed bacterial septic arthritis which may have contributed to the slip. He was treated with an initial debridement followed by a definitive pelvic support osteotomy (PSO) with a compensatory distal femoral varus osteotomy. At 12 months, he had a satisfactory clinical and radiological outcome.
UNASSIGNED: Clinicians should have a high degree of suspicion for infection in patients presenting with atypical clinical or radiological signs of SCFE. A thorough investigation in such cases is a must, to aid in correct management. PSO is an effective salvage procedure in adolescents with septic hip sequelae.

UNASSIGNED: Slipped capital femoral epiphysis (SCFE) is commonly managed by in situ screw fixation. However, higher grades of slips require restoration of normal anatomy of the femoral head without compromising the blood supply.
UNASSIGNED: A 16-year-old adolescent male presented with the left hip pain and progressive limping for 4 days with no history of previous trauma. On examination, the patient had severe tenderness and gross restriction of movements. Radiological examination revealed Grade 2 acute on chronic SCFE with unstable slip. Modified Dunn procedure through Ganz surgical hip dislocation facilitated the complete restoration of normal anatomy without avascular necrosis of femoral head changes at 2 years of follow-up.
UNASSIGNED: Ganz safe surgical dislocation of the hip is safe for the femoral head, preserving its blood supply in toto and the modified Dunn procedure facilitated the complete restoration of normal anatomy even in acute on chronic type of SCFE cases.

Slipped capital femoral epiphyses (SCFE) is considered to be a very common disorder among adolescent age group. Multiple risk factors have been reported such as obesity, endocrine disorders, vitamin D deficiency, and panhypopituitarism. The diagnosis of SCFE is important especially in its early stages as this would prevent complications and delay in surgical intervention. The diagnosis is mainly done by radiological imaging and clinical evaluation. However, clinical evaluation is often overlooked. Herein, we present a case of a seven-year-old with SCFE that was diagnosed late due to negative radiological imaging and received late surgical intervention. Therefore, it is recommended that orthopedic surgeons use their clinical sense and examination skills to diagnose SCFE promptly, in order to maintain a short follow-up window to prevent any delay in surgical management and to observe for any progression, even if the radiological findings are normal.

BACKGROUND: Slipped capital femoral epiphysis (SCFE) requires surgical treatment when diagnosed. The surgical management of moderate to severe SCFE remains an area of controversy among pediatric orthopedic surgeons. The severity of slippage, the viability of the femoral epiphysis, and the method of surgical management determine the long-term clinical and radiographical outcome. This study sought to evaluate the mid-term results of subcapital realignment of chronic stable slipped femoral epiphysis with open physis using surgical hip dislocation.
METHODS: This study was a prospective case series of adolescents with moderate or severe degrees of chronic SCFE who had undergone subcapital osteotomy using the surgical hip dislocation technique. The Harris Hip Score (HHS) was used to assess functional outcomes at 6 years of follow-up. A HHS of ≥ 80 points was considered satisfactory. Postoperative radiological outcomes were evaluated using epiphyseal-shaft angles and alpha angles. Postoperative complications were observed.
RESULTS: This study included 40 patients, 32 (80%) males and 8 (20%) females, with a mean age of 14.1 ± 1.8 years. There was a statistically significant improvement in the mean HHS from 45 ± 12.3 preoperatively to 91.8 ± 11.6 points at 6 years of follow-up. The mean epiphyseal-shaft angle reduced from 60.5 ± 15.3° preoperatively to 10.3 ± 2.4° postoperatively, P < 0.001. The mean alpha angle reduced from 72.5 ± 10.1° preoperatively to 40.4 ± 6.4°, P < 0.001. Four (10%) patients showed femoral head avascular necrosis (AVN).
CONCLUSIONS: Subcapital realignment of chronic SCFE can achieve satisfactory clinical and radiological outcomes, but femoral head AVN remains a risk. Level of evidence Level IV.

UNASSIGNED: Slipped capital femoral epiphysis (SCFE) is rare in adults and is often associated with endocrine pathology.
UNASSIGNED: We report a case of a 21-year-old male presenting with an acute on chronic left hip SCFE who was diagnosed with primary hypothyroidism on the investigation. The patient was treated for hypothyroidism and positional reduction with in-situ fixation was carried out with two cannulated cancellous screws for the SCFE. At the latest follow-up of 30 months, patient remains asymptomatic, euthyroid, with a nearly full range of motion in the hips, significant functional improvement, fused physis on radiographs, and no signs of avascular necrosis.
UNASSIGNED: SCFE is a potentially devastating but avoidable complication in children/adults with the endocrine disorder and there may be a possible role for a screening pelvic radiograph in detecting this condition earlier.

BACKGROUND: There is little consensus on the best treatment algorithm for unstable severe slipped capital femoral epiphysis (SCFE). Subcapital osteotomy, which is one of the surgical options, is performed either anteriorly (anterior cuneiform osteotomy, CO) or laterally with trochanteric osteotomy (Dunn procedure, DP). The CO is technically easier and decreases operating time. Moreover, because the DP was standard in our department before it was replaced by the CO, we had a series of consecutive patients. Therefore we did a retrospective case-control study in unstable severe SCFEs treated by CO versus DP, which is to our knowledge the first one aiming to compare: 1) postoperative complications and in particular avascular necrosis, 2) functional outcome, 3) radiologic findings.
OBJECTIVE: CO is less or just as likely to cause avascular necrosis and has the same clinical and radiologic findings as DP.
METHODS: A total of 41 patients (24 girls, i.e. 58.5%) were included between 2005 and 2018: 23 in the CO group and 18 in the DP group. The median age was 12.9 years (range, 11.5-14.9) and the median slip angle 70° (range, 62.5°-80°) with a median follow-up of 3 years (range, 2-4). Preoperative, intraoperative, and postoperative clinical and radiologic parameters (Southwick and alpha angles, and femoral head-neck offset) were analyzed, and all complications were documented.
RESULTS: Two (8.7%) cases of avascular necrosis were reported in the CO group and 6 (33.3%) in the DP group (p =.11), with an overall rate of avascular necrosis of 19.5% (8/41). Five out of the 41 patients (12.2%) underwent a total hip arthroplasty: 1/23 (4.3%) in the CO group and 4/18 (22.2%) in the DP group (p =.16). Two (9.5%) patients in the CO group and 7 (38.9%) in the DP group developed postoperative limping before any arthroplasty was performed (p =.055).The alpha angle at follow-up (54 ± 6.1° vs. 59.1 ± 7.2°; (p =.027)), Oxford hip score at follow-up (17/60 (range, 14-20) vs. 23.5 (range, 19-27) (p=.021), operating time (132 min (range, 103-166) vs. 199.5 min (range, 142-215)) (p =.011) and intraoperative bleeding (250 mL (range, 100-350) vs. 300 mL (range, 197-450)) (p =.088) were more favorable in the CO group than in the DP group.
CONCLUSIONS: The CO has similar results to DP in the surgical management of unstable severe SCFE.
METHODS: III; retrospective comparative study.