H J Hellmich1, A H Krieg2. 1. Kinderorthopädie, Universitätskinderspital beider Basel (UKBB), Spitalstrasse 33, 4056, Basel, Schweiz. hermann-josef.hellmich@ukbb.ch. 2. Kinderorthopädie, Universitätskinderspital beider Basel (UKBB), Spitalstrasse 33, 4056, Basel, Schweiz.
Abstract
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is the most significant hip disease in adolescence. Because of its typical occurrence at the time of the pubertal growth spurt and some particular clinical symptoms, it has been a topic of special interest in orthopedic research for a long time. A large number of etiological factors have been described, however their meaning in detail is still controversial. OBJECTIVES: After a short summary of the structure and function of the epiphysis, an overview of concepts in the pathogenesis of SCFE is given. MATERIALS AND METHODS: A selective review of literature was performed. RESULTS: Etiology of SCFE includes genetic, endocrinologic, histochemical and biomechanical factors. During puberty, obesity together with reduced femoral antetorsion are the main risk factors for the disease. The rarer atypical SCFE is closely related to metabolic disorders or other chronical diseases. The pathogenesis is characterized by the disproportion between the load-bearing capacity of the epiphysis and the acting forces on the proximal femur. CONCLUSIONS: The concept of the multifactorial etiology of SCFE is convincing. The susceptibility of the femoral epiphysis is explained considering the remarkable biomechanic local forces. The initial damage can be shown on the histological and the histochemical level. Important new aspects refer to the leptin-metabolism. However, in the majority of cases, biomechanical factors seem to be more significant than endocrinological phenomena. A complete understanding has not succeeded to date.
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is the most significant hip disease in adolescence. Because of its typical occurrence at the time of the pubertal growth spurt and some particular clinical symptoms, it has been a topic of special interest in orthopedic research for a long time. A large number of etiological factors have been described, however their meaning in detail is still controversial. OBJECTIVES: After a short summary of the structure and function of the epiphysis, an overview of concepts in the pathogenesis of SCFE is given. MATERIALS AND METHODS: A selective review of literature was performed. RESULTS: Etiology of SCFE includes genetic, endocrinologic, histochemical and biomechanical factors. During puberty, obesity together with reduced femoral antetorsion are the main risk factors for the disease. The rarer atypical SCFE is closely related to metabolic disorders or other chronical diseases. The pathogenesis is characterized by the disproportion between the load-bearing capacity of the epiphysis and the acting forces on the proximal femur. CONCLUSIONS: The concept of the multifactorial etiology of SCFE is convincing. The susceptibility of the femoral epiphysis is explained considering the remarkable biomechanic local forces. The initial damage can be shown on the histological and the histochemical level. Important new aspects refer to the leptin-metabolism. However, in the majority of cases, biomechanical factors seem to be more significant than endocrinological phenomena. A complete understanding has not succeeded to date.
Entities:
Keywords:
Endocrinopathy; Femoral antetorsion; Hip; Obesity; Slipped capital femoral epiphysis
Authors: Gustavo Remigio Gomes; David Israel DE Carvalho Nascimento; Davi Coutinho Fonseca Fernandes Gomes; Lucas Henrique Araujo DE Oliveira; Túlio Vinícius DE Oliveira Campos; Marco Antonio Percope DE Andrade Journal: Acta Ortop Bras Date: 2021 Jul-Aug Impact factor: 0.513