Valgus slipped capital femoral epiphysis: a systematic review

Valgus slipped capital femoral epiphysis (SCFE) is a rare entity which leads to a proximolateral displacement of the hip epiphysis. The literature on valgus SCFE consists of case reports or case series. Since no evidence synthesis has been conducted, a systematic review on all published cases of valgus SCFE was conducted. The search strategy located 27 studies comprising 74 subjects with 96 hips. Demographic results were as follows: female/male ratio was of 1.65, and the mean age at presentation was 13.0 +/- 2.54 years. Bilateral cases were recorded in 31.1%. Hip pain was the most frequent symptom followed by limping. The most frequent clinical sign was the limitation of medial internal rotation. Comorbidities were present in 65.6% of patients, mostly as endocrine or metabolic disorders. The mean neck-shaft angle was 149.2 +/- 9.2 degrees, the mean physis-shaft angle was 83.3 +/- 9.7 degrees, the neck-physis angle was 36.1 +/- 21.5 degrees, and the posterior physeal tilt angle was 23 +/- 6.07 degrees. The physeal tilt was lateral in 90% of cases. Treatment was based on screws in 70.8% of cases, a femoral osteotomy in 18.75%, and the remaining had a combination of surgical procedures. Two out of the three screw migrations occurred following fixation with more than one screw. All major complications (8.3%) had the potential of developing osteoarthritis in the future. Valgus SCFE entity demonstrates distinctive demographic, clinical and radiological results. This rare entity should be always included in the differential diagnosis of hip pain or limping in children.