Slipped capital femoral epiphysis
Summary
Definition
Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in the adolescent age group. It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis.
SCFE is a misnomer; it is the metaphysis that displaces anteriorly and superiorly, leading to the slipped state.[1][2] Weakness in the growth plate can be caused by a variety of factors, including stress on the growth plate due to obesity, and endocrine disorders such as panhypopituitarism, hypothyroidism, and renal osteodystrophy. A period of rapid growth in adolescence may also weaken the epiphyseal plate.[1] Klein lines are drawn along the superior cortex of the femoral neck. Plain anteroposterior/frog-leg lateral radiographs show the Klein line not intersecting the femoral head in hips with SCFE. Valgus SCFE is defined as posterolateral slippage of the proximal femoral epiphysis on the metaphysis.[3][Figure caption and citation for the preceding image starts]: Klein lines are drawn along the superior cortex of the femoral neck. A normal Klein line will intersect the epiphysis. An abnormal Klein line does not intersect the epiphysis, as the femoral neck has moved proximally and anteriorly relative to the epiphysisImage courtesy of John M. Flynn, MD [Citation ends].
History and exam
Key diagnostic factors
- presence of risk factors
- weight (>90th percentile)
- gait with affected leg externally rotated
Other diagnostic factors
- groin or knee pain
- bilateral hip pain
- Trendelenburg's gait
- restricted range of motion
- weight (<50th percentile)
- symptoms of hypothyroidism or panhypopituitarism
- renal failure
- recent trauma
Risk factors
- puberty
- obesity
- male sex
- endocrine disorders
- ancestry
- geographic region
- prior radiotherapy
Diagnostic investigations
1st investigations to order
- bilateral antero-posterior x-rays
- frog-leg lateral x-rays
Investigations to consider
- metabolic panel
- serum thyroid function tests
- serum growth hormone
Treatment algorithm
unstable SCFE
stable SCFE
late deformity
Contributors
Authors
Randall T. Loder, MD
George J. Garceau Professor of Pediatric Orthopaedic Surgery
Indiana University School of Medicine
Indianapolis
IN
Disclosures
RTL is on the editorial board of JPO and JCO. He has provided expert testimony regarding slipped capital femoral epiphysis and received book royalties. RTL is an author of a number of references cited in this topic.
Acknowledgements
Dr Randall T. Loder would like to gratefully acknowledge Dr John M. Flynn, Dr Purushottam A. Gholve, Dr Danielle B. Cameron, and Dr Patrick O'Toole, previous contributors to this topic. JMF, PAG, DBC, and PO declare that they have no competing interests.
Peer reviewers
James McCarthy, MD, FAAOS, FAAP
Associate Professor
Department of Orthopedics and Rehabilitation
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
JM declares that he has no competing interests.
D. Philip Thomas, MB, BS, FRCS
Consultant Orthopaedic Surgeon and Honorary Lecturer
University Hospital of Wales
Cardiff
UK
Disclosures
DPT declares that he has no competing interests.
Nicholas M. Clarke, ChM, FRCS
Professor
Consultant Orthopaedic Surgeon
Developmental Origins of Health and Disease (DOHaD)
School of Medicine
University of Southampton
Southampton
UK
Disclosures
NMC has received honoraria for visiting professorships in North America and also for lectures in respect of congenital hip dysplasia. He is also a founding member of the International Hip Dysplasia Institute, which has received charitable funding.
Differentials
- Hip fractures
- Avascular necrosis
- Legg-Calve-Perthes' disease
More DifferentialsGuidelines
- Open reduction of slipped capital femoral epiphysis
More Guidelines
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