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Slipped Capital Femoral Epiphysis (SCFE)

by David D. Sherry, MD, Frank Pessler, MD, PhD

Slipped capital femoral epiphysis (SCFE) is movement of the femoral neck upward and forward on the femoral epiphysis.

SCFE usually occurs in early adolescence and preferentially affects boys. Obesity is a significant risk factor. Genetic factors also contribute. SCFE is bilateral in one fifth of patients, and unilateral SCFE becomes bilateral in up to two thirds of patients. The exact cause is unknown but probably relates to weakening of the physis (growth plate), which can result from trauma, hormonal changes, inflammation, or increased shearing forces due to obesity.

Symptoms and Signs

Onset is usually insidious, and symptoms are associated with stage of slippage. The first symptom may be hip stiffness that abates with rest; it is followed by a limp, then hip pain that radiates down the anteromedial thigh to the knee. Up to 15% of patients present with knee or thigh pain, and the true problem (hip) may be missed until slippage worsens. Early hip examination may detect neither pain nor limitation of movement. In more advanced stages, findings may include pain during movement of the affected hip, with limited flexion, abduction, and medial rotation; knee pain without specific knee abnormalities; and a limp or Trendelenburg gait. The affected leg is externally rotated. If blood supply to the area is compromised, avascular necrosis and collapse of the epiphysis may occur.

Diagnosis

  • Plain x-rays

  • Sometimes MRI or ultrasonography

Because treatment of advanced slippage is difficult, early diagnosis is vital. Anteroposterior and frog-leg lateral x-rays of both hips are taken. X-rays show widening of the epiphyseal line or apparent posterior and inferior displacement of the femoral head. Ultrasonography and MRI are also useful, especially if x-rays are normal.

Treatment

  • Surgical repair

SCFE usually progresses; it requires surgery as soon as it is diagnosed. Patients should not bear weight on the affected leg until SCFE has been ruled out or treated. Surgical treatment consists of screw fixation through the physis.

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