Lindgren Amelia M, Lieber Alexander M, Shah Suken A, Thacker Mihir M
Nemours Children's Health, Department of Orthopaedic Surgery, Wilmington, DE.
Mount Sinai Hospital, Department of Orthopaedic Surgery, New York, NY.
J Pediatr Soc North Am. 2024 Feb 12;5(3):727. doi: 10.55275/JPOSNA-2023-727. eCollection 2023 Aug.
Atypical slipped capital femoral epiphyseal (SCFE) is associated with endocrine or metabolic disorders and radiation therapy. In this review, we use case examples of hyperparathyroidism, hypothyroidism, and growth hormone deficiency, as well as renal osteodystrophy, radiation-induced, and valgus SCFE to inform the nuances of these unusual cases. From this, we learn that routine laboratory screening of "typical" patients with SCFE is not cost-effective. Patients with atypical SCFE are often short in stature, underweight, and present either older or younger than the typical age range of idiopathic SCFE. Patients fitting these criteria should undergo an endocrine workup. While uncommon, prompt recognition of atypical SCFE is crucial, as coordinated care with pediatric subspecialists is necessary. In situ fixation with cannulated screws is the most common fixation method, and bilateral fixation is recommended.
•Patients younger than 10 or older than 16 years of age and patients with height, weight, or BMI below the 50 percentile should undergo laboratory screening for atypical SCFE.•Patients presenting with a valgus slip should undergo screening labs for atypical SCFE.•Patients presenting with a unilateral SCFE with underlying endocrinopathy, metabolic disorder, or when associated with radiation therapy should undergo bilateral fixation.
非典型性股骨头骨骺滑脱（SCFE）与内分泌或代谢紊乱以及放射治疗有关。在本综述中，我们使用甲状旁腺功能亢进、甲状腺功能减退和生长激素缺乏的病例，以及肾性骨营养不良、放射诱导性和外翻性SCFE的病例来阐述这些不寻常病例的细微差别。从中我们了解到，对“典型”SCFE患者进行常规实验室筛查并不具有成本效益。非典型SCFE患者通常身材矮小、体重不足，发病年龄比特发性SCFE的典型年龄范围大或小。符合这些标准的患者应接受内分泌检查。虽然不常见，但及时识别非典型SCFE至关重要，因为需要与儿科亚专科医生进行协调治疗。空心螺钉原位固定是最常见的固定方法，建议进行双侧固定。
•10岁以下或16岁以上的患者以及身高、体重或BMI低于第50百分位数的患者应接受非典型SCFE的实验室筛查。•表现为外翻滑脱的患者应接受非典型SCFE的筛查实验室检查。•表现为单侧SCFE且伴有潜在内分泌病、代谢紊乱或与放射治疗相关的患者应进行双侧固定。
