Slipped capital femoral epiphysis
Background
- Abbreviation: SCFE
- Most common cause of hip disability in adolescents
- Head of femur displaces from epiphysis
- Common complications: avascular necrosis of femoral head (increased risk with high grade slip), arthritis
Risk Factors
- Obesity
- Black race
- Male sex (male:female 3:1)
- Times of high growth velocity (male growth spurt, around 13 years; female growth spurt, around 11 years)
- Left hip more common
- Endocrine disorders
- Hypothyroid common
- High clinical concern for SCFE in children less than <10 yrs of age
Clinical Features
- Mild to severe pain hip pain
- Often present with referred knee pain
- Abnormal gait
- Limp
- Weakness
- Thigh atrophy
- Externally rotated hip
- Loss of internal rotation
- Loss of abduction
- Loss of flexion
- May present as acute (unstable), chronic (stable), or acute on chronic (following trauma)
Differential Diagnosis
Pediatric hip pain
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Evaluation
- Plain radiographs of the hip (bilateral AP and frog-leg views)
- Widened physis (early finding)
- Displacement of femoral neck to head (late finding, so called 'ice cream cone' sign)
- May show necrosis of the femoral head in late cases complicated by avascular necrosis
- Note that up to 40% of patients will have bilateral involvement [1]
- Klein's line
- Line from superior cortex of femoral neck parallel to greater trochanter
- Normally should cross through 1/3 of femoral head
- If does not cross the femoral head, highly suspicious for SCFE
- May require MRI in ambiguous cases
Management
- Orthopedic surgery consultation in ED
- Strict non-weight bearing
- Pain control
- Internal fixation
- Performed immediately for unstable SCFE
- May be delayed by a few days for stable SCFE
Disposition
- Admit
External Links
See Also
References
- ↑ Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.