Chapter 109: Slipped Capital Femoral Epiphysis

High-Yield Facts

• The classic presentation of slipped capital femoral epiphysis (SCFE) is that of an obese adolescent with nonradiating, dull, aching pain in the hip, groin, thigh, or knee without a history of trauma.

• Patients with SCFE may also present with isolated thigh or knee pain.

• The traditional classification of SCFE is based on intensity and duration of symptoms into four patterns of presentation: pre-slip, acute, acute on chronic, and chronic.

• Imaging requires both lateral and AP views of the hip.

• The goals of treatment of SCFE are to prevent further slipping by stabilizing the diseased physis and preventing further growth complications.

SCFE is characterized by a displacement of the capital femoral epiphysis from the femoral neck through the physeal plate. It is one of the most common hip disorders of adolescence, with an overall. There is an overall incidence of 10.8 per 100,000.¹ The average age at the time of diagnosis is 11 to 12 years for girls and 12.5 to 13.5 years for boys.^1–3 SCFE is more common in males than females with a ratio of approximately 1.5 to 1 and is more frequent in African Americans and Hispanics^1,3 Obesity is a significant risk factor in the development of SCFE as approximately one-half of children who acquire a SCFE have weights at or above the 95th percentile.^4,5 About 10% to 20% of children have bilateral slippage at presentation, and another 10% to 20% are diagnosed subsequently with a second slip during adolescence.^6,7

Diagnosis

The two most common features of the presentation of SCFE are pain and altered gait. The classic presentation is that of an obese adolescent with a complaint of nonradiating, dull, aching pain in the hip, groin, thigh, or knee without a history of trauma. However, 15% of patients present with isolated thigh or knee pain.⁸ SCFE is more likely to be missed at the initial visit if hip pain is absent or thigh pain is present.

SCFE has traditionally been classified based on intensity and duration of symptoms into four patterns of presentation: pre-slip, acute, acute on chronic, and chronic.

Pre-slips refer to those with pain but without discernable displacement of the epiphysis.

Children with acute slips have symptoms of less than 3 weeks duration. The acute presentation is often associated with trauma. The symptoms are characterized by the onset of severe pain, external rotational deformity and limitation of motion of the hip, shortening, and frequently inability to bear weight. Active motion of the hip is severely limited by muscle spasm, and the patient complains of intense pain with any attempt at passive motion.

The acute on chronic presentation occurs when a patient with an extended history of symptoms, and signs of chronic SCFE presents with an acute increase in ...