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.
Slipped Capital Femoral Epiphysis. Anteroposterior radiograph (A) demonstrating left SCFE. Frog-leg radiograph (B) showing posterior displacement in SCFE. (Reproduced with permission from Skinner HB, McMahon PJ. Current Diagnosis & Treatment in Orthopedics, 5th ed. New York, NY: McGraw Hill; 2014.)
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.
The differential diagnosis includes septic arthritis, but patients with SCFE will have normal labs and absence of systemic symptoms.
Obesity and hypothyroidism increase the risk of SCFE development.
SCFE can be bilateral in 20% of patients.
Slipped Capital Femoral Epiphysis. Klein’s lines (white lines) are drawn along the superior edge of the femoral neck in this radiograph. On the right hip (normal), Klein’s line intersects the epiphysis. On the left hip (SCFE), Klein’s line is lateral to the epiphysis. (Reproduced with permission from Elsayes KM, Oldham SA. Introduction to Diagnostic Radiology. New York, NY: McGraw Hill; 2014.)