Slipped capital femoral epiphysis

Background

• Abbreviation: SCFE
• Most common cause of hip disability in adolescents
• Head of femur displaces from epiphysis
• Complications: avascular necrosis, arthritis

Risk Factors

• Obesity
• Black patients
• Male:female (3:1)
• During growth spurt (m=13y f=11y)
• Left hip more common
• Associated with endocrine disorders
  • Hypothyroid common
  • high clinical concern for <10 yrs of age

Clinical Features

• Mild to severe pain hip pain (may have referred knee pain)
• abnormal gait
• Limp, weakness, thigh atrophy
• externally rotated hip
• loss of internal rotation, abduction, and flexion
• May present as acute, chronic, or acute on chronic (following trauma)

Differential Diagnosis

Pediatric limp

Hip Related

• 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

Other Causes of Limping

• Developmental dysplasia
• Fracture
  • Toddler's fracture
  • Tillaux fracture, adolescent
• Neoplasm:
  • Leukemia
  • Ewings
  • Osteogenic sarcoma
  • Metastatic neuroblastoma
• Osteomyelitis
• Myositis
• Other:
  • Appendicitis
  • Meningitis
  • Epidural abscess (spinal)

Evaluation

• AP, Frog Leg Lateral View B/L
  • Widened physis (early finding)
  • Displacement of femoral neck to head (late finding)
  • Frog Leg view of both sides: high proportion have b/l involvement
• Klein's line
  • Line from superior cortex of femoral neck parallel to greater trochanter
    • Normally should cross through 1/3 of femoral head

Management

• Orthopedic consultation in ED; pinning
• MRI for ambiguous cases
• Non-weight bearing
• Internal fixation

Common Complications

• Avascular necrosis of femoral head; increased risk with high grade slip
• contralateral SCFE

Disposition

• Admit

See Also

• Hip Pain
• Hip Pain (Peds)
• Limp (Peds)

References

• Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
• AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009