Unstable: unable to bear weight even with the use of crutches as symptoms are more severe.Stable: able to bear weight on the affected side with or without crutches.This type of classification is predictive of prognosis and accounts for nearly 90% of all SCFE cases.

Loder Classification: classifies cases as stable or unstable based on ability to bear weight. SCFE can be classified according to stability, severity, symptom duration by using the following classification systems 8 7 Disease progression including natural history, disease phases or stages, disease trajectory (clinical features and presentation over time) Classification Insufficiency of the femoral physis can be attributed to mechanical factors, such as obesity, morphologic abnormalities of the femoroacetabular joint and other external variables that increase the axial load and shear forces applied to the growth plate which ultimately predispose it to slippage. It is believed to arise due to a mechanical displacement of the proximal femoral head from the femoral neck due to abnormal physiological loads through a skeletally weak and immature physeal growth plate. Pathogenesis of SCFE has many theories, however, the exact mechanism is still to be determined. 1,4 Presentation outside of these age ranges should raise clinical concern for potential endocrinopathies or chronic conditions that lead to high bone turnover. SCFE usually occurs during adolescence, typically during the ages of 8 through 15 and is more common in males than females (male to female ratio of 1.6:1) with an average age of 13.5 years in males and 12 years in females. 4 African-Americans, Pacific Islanders and the Hispanic population have greater predisposition for the development of SCFE than Caucasians. Prevalence varies widely among race, seasonal and geographic location with higher presentations in the northern and western United States. SCFE is the most common hip disorder in pre-adolescents, adolescents, and young adults with an overall prevalence of 10.8 cases per 100,000 children. 3 Epidemiology including risk factors and primary prevention 1 Proper development of the physis requires thyroid hormone, vitamin D, and calcium. Renal and endocrine abnormalities such as hypothyroidism, panhypopituitarism and renal osteodystrophy are also linked to the development of SCFE. Mechanical risk factors for SCFE include rapid growth spurts, femoral retroversion, and femoral neck shaft angle. Obesity is the most common risk factor with 63% of cases above the 90th weight percentile. 1 EtiologyĮtiology is multifactorial with most cases being idiopathic. It is characterized by insidious onset dull hip or referred knee pain, usually without preceding trauma. Slipped Capital Femoral Epiphysis (SCFE) is a hip disorder resulting in posteroinferior displacement of the proximal femoral epiphysis (femoral head) in relation to the metaphysis (femoral neck), through a skeletally immature physeal growth plate. Multiple Sclerosis and Transverse Myelitis in Children.Severe Pediatric Traumatic Brain Injury.Vascular Malformations of the Brain and Spine in Children.Spinal Cord Injury Without Radiological Abnormality.Mild to Moderate Pediatric Traumatic Brain Injury.Mitochondrial Disorders Part One: Disease/Disorder, Essentials of Assessment.Mitochondrial Disorders Part Two: Rehabilitation Management, Concepts, and Gaps in Knowledge.

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