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Slipped Capital Femoral Epiphysis
➤ Slipped Capital Femoral Epiphysis is a disorder primarily
affecting adolescents in which the femoral head (epiphysis)
slips posteriorly and inferiorly from the femoral neck through
the growth plate (physis). Obesity is a significant risk factor,
as the increased mechanical stress on the weakened growth
plate, particularly during periods of rapid growth, predisposes
it to slippage. Hormonal factors (e.g., hypothyroidism, growth
hormone imbalances) can further undermine the physis. Notable
signs and symptoms include pain radiating to the groin, inner
thigh, or knee (often due to referred pain), accompanied by a limp
with external rotation of the affected extremity and restricted
internal rotation and abduction on examination. Range of motion
is especially limited in internal rotation, and weight-bearing may
become impossible in severe cases. Radiography with anterior-
posterior and frog-leg views may show posterior and medial
displacement of the femoral head in relation to the femoral neck
or the "scoop of ice cream falling off the cone" appearance. Acute
onset often follows minor trauma, while chronic cases develop
gradually; without prompt treatment, there is an increased risk of
osteonecrosis and chondrolysis.
Blount Disease (Tibia Vara)
➤ Blount disease is a growth disorder characterized by abnormal
growth of the proximal medial tibial physis, resulting in a
progressive varus (bowing) deformity of the lower leg. While
the exact cause is unknown, it is thought to be multifactorial,
with mechanical stress playing a significant role. Obesity and
early walking in young children increase compressive forces on
the medial tibia, which can inhibit normal growth in that area.
Meanwhile, the lateral side continues to grow, resulting in the
characteristic bowing. Notable signs and symptoms include
progressive bowing of one or both lower legs (usually just below
the knee, forming a characteristic C shape), which distinguishes
this condition from physiological bowing, which typically resolves
with age. Affected individuals may exhibit a waddling gait and
experience knee pain, particularly during adolescence and with
physical activity. If left untreated, severe cases can lead to leg-
length discrepancy, joint instability, and premature osteoarthritis
of the knee.
