Slipped Capital Femoral Epiphysis Clinical Presentation

  • Author: Kevin D Walter, MD, FAAP; Chief Editor: Craig C Young, MD   more...
 
Updated: Aug 11, 2011
 

History

  • Slipped capital femoral epiphysis (SCFE) is most common in the adolescent period (ie, boys aged 10-16 y, girls aged 12-14 y). Males have 2.4 times the risk compared with females.
  • The left hip is affected more commonly than the right.
  • Obesity is a risk factor because it places more shear forces around the proximal growth plate in the hip at risk.[18, 19]
  • The duration, location, and radiation of pain are important, as is the ability to bear weight.
  • Genetics may play a role in SCFE because the rate of familial involvement is 5-7%, with a large variability in penetrance.
  • In patients younger than 10 years, SCFE is associated with metabolic endocrine disorders (eg, hypothyroidism, panhypopituitarism, hypogonadism, renal osteodystrophy, growth hormone abnormalities).[1, 20, 21] Bilaterality is more common in these younger patients.
  • The chronicity of the condition should be determined.
    • Prodromal symptoms (eg, hip or knee pain, limp, decreased range of motion) for less than 3 weeks are deemed acute.
    • Prodromal symptoms for longer than 3 weeks are deemed chronic.
    • If a patient reports symptoms of greater than 3 weeks' duration but presents with an acute exacerbation of pain, limp, inability to bear weight, or decreased range of motion with or without an associated traumatic episode, the SCFE is categorized as acute on chronic.
    • Determine if a traumatic episode occurred.
  • It is important to determine if the lesion is stable or unstable.
    • "Stable" SCFEs allow the patient to ambulate with or without crutches.[6]
    • "Unstable" SCFEs do not allow the patient to ambulate at all; these cases carry a higher rate of complication, particularly of AVN.[6]
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Physical

  • If a patient reports knee pain, always examine the hip, because knee pain may be referred pain from the hip via the obturator nerve.
  • Obesity increases a clinician's index of suspicion for SCFE.
  • Patients often hold their affected hip in passive external rotation.
  • Determine the patient's ability to bear weight (stable vs unstable).
  • If the patient is ambulatory, determine the his or her gait pattern:
    • Antalgic – Shortened stance phase on the affected side
    • Out-toeing
  • Always examine both hips. Assess the active and passive range of motion in both hips. In patients with unilateral complaints, this comparison allows the clinician to compare the affected and unaffected sides for differences. Internal and external rotation are best tested with the patient in the prone position with the knees flexed to 90 º.
    • If SCFE is present, the lower extremity may externally rotate and abduct with gentle passive hip flexion.
    • Internal rotation is decreased in nearly all hips with SCFE. Internal rotation is often painful.
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Contributor Information and Disclosures
Author

Kevin D Walter, MD, FAAP  Assistant Professor, Department of Pediatric Orthopaedics and Department of Pediatrics, Medical College of Wisconsin; Member of Children's Specialty Group of Children's Hospital of Wisconsin; Program Director, Children's Hospital of Wisconsin Pediatric and Adolescent Primary Care Sports Medicine

Kevin D Walter, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

David Y Lin, MD  Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic

David Y Lin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Evan Schwartz, MD  Director of Orthopedic Surgery, New York Medical College; Assistant Professor, St John's Queens Hospital, Department of Surgery, Albert Einstein School of Medicine

Evan Schwartz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Anthony J Saglimbeni, MD  President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD, is a member of the following medical societies: California Medical Association and Santa Clara County Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Henry Marano, MD, to the development and writing of this article.

References

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A Klein line is a line drawn along the superior border of the femoral neck that would normally pass through a portion of the femoral head. If not, slipped capital femoral epiphysis is diagnosed.
X-ray of a hip following operative percutaneous fixation of a slipped capital femoral epiphysis.
 
 
 
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