Slipped capital femoral epiphysis

Background

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

Risk Factors

• Obesity
• African-American
• Male:female (3:1)
• During growth spurt (m=13y f=11y)
• L Hip more common
• Associated w/ Endocrine Disorders
  • hypothyroid common
  • high clinical concern for <10 yrs of age

DDX

Hip Pain (Peds)

Diagnosis

Presentation

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

Imaging

• 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

Treatment

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

Common Complications

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

Disposition

Admission

See Also

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

Source

• Tintinalli
• 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