A comparison of varus and valgus slipped capital femoral epiphysis: a case series




Bowman, W.
Mayfield, Matthew


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Introduction: Slipped capital femoral epiphysis (SCFE) is an infrequent adolescent hip disorder. The most common presentation of SCFE is varus slip, a posterior and inferior displacement of the proximal femoral epiphysis on the femoral metaphysis; however, SCFE also presents less frequently as a valgus slip, a posterior and lateral displacement. SCFE is often first seen by a family physician before prompt referral to an orthopedist. The family physician’s immediate recognition and diagnosis of this emergent condition is crucial. Methods: These cases were identified and reviewed using electronic medical records and imaging. Results: Case 1 is an 11-year-old obese boy with pain for several months due to left unilateral varus SCFE. Surgical management consisted of situ pinning and prophylactic pinning in the contralateral right hip. Case 2 is a 12-year-old obese boy with acute traumatic pain who had right unilateral varus SCFE, was managed with in situ pinning, and has suspected pre-slippage of the contralateral left hip. Case 3 is an 11-year-old non-obese girl with acute pain who had simultaneous bilateral valgus SCFE, underwent in situ pinning twice because of hardware complications, and later required removal of previously placed hardware. Conclusions: Varus SCFE tends to occur more often in males and valgus slips tend to occur more in females. Body mass index (BMI) seems to show little indication on whether the slip will be varus or valgus. Varus slips commonly present unilaterally with the potential to progress to sequential bilateral slips, while valgus slips have a greater probability of presenting as simultaneous bilateral slips.