Slipped capital femoral epiphysis

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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 hip pain

Evaluation

  • Plain radiographs of the hip (bilat AP and Frog Leg views)
    • Widened physis (early finding)
    • Displacement of femoral neck to head (late finding)
    • Frog Leg view of both sides: up to 40% have b/l 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
  • May require MRI in ambiguous cases

Management

  • Orthopedic surgery consultation in ED
  • Non-weight bearing
  • Internal fixation

Common Complications

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

Disposition

  • Admit

See Also

References

  1. Mick N. Pediatric orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.