12-27: Slipped Capital Femoral Epiphysis

Clinical Summary

Slipped capital femoral epiphysis (SCFE) typically affects adolescents during a growth spurt. This condition is more common in boys, and it typically occurs between ages 13 and 16. Patients present with hip pain or referred pain to the knee. These patients commonly have a limp. On physical exam, the affected leg may be externally rotated and shortened.

Klein’s line can be drawn on a plain anteroposterior radiograph to diagnose this condition. This line is drawn along the superior edge of the femoral neck on a radiograph. In a normal hip, Klein’s line should intersect the epiphysis. In an SCFE, Klein’s line will not intersect the epiphysis.

Management and Disposition

Orthopedic surgery should be consulted for operative management. If left untreated, complications include osteoarthritis, limb length discrepancy, and avascular necrosis of the femoral head. Patients with an SCFE need to be made non–weight bearing immediately in the emergency department to prevent further deformity.

Pearls

1. The differential diagnosis includes septic arthritis, but patients with SCFE will have normal labs and absence of systemic symptoms.

2. Obesity and hypothyroidism increase the risk of SCFE development.

3. SCFE can be bilateral in 20% of patients.