Slipped Capital Femoral Epiphysis Workup

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

Laboratory Studies

Routine hormonal screening of children with slipped capital femoral epiphysis (SCFE) is not indicated.

Appropriate laboratory tests should be completed for endocrinopathies and medical disorders (hypothyroidism, low growth hormone level, pituitary tumors, craniopharyngioma, Down syndrome, renal osteodystrophy, and adiposogenital syndrome) in patients with an atypical presentation or other findings on history and physical examination that are consistent with endocrinologic disorders. Atypical presentation is considered for children who present with SCFE who are younger than age 10 years or older than 16 years, as well as for children who present with SCFE and short stature. It is also worth considering endocrinology laboratory testing for a patient who is not obese but who falls within the 10- to 16-year age range.

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Imaging Studies

Obtain anteroposterior and frog-lateral radiographs of the pelvis or bilateral hips.

  • Determine the amount of head displacement off the femoral neck as a percentage to classify the degree of slippage.
    • Type I slippage is less than 33% displacement.
    • Type II slippage is between 33% and 50% displacement.
    • Type III slippage is greater than 50% displacement.
  • Note any bony changes of the femoral neck and head because they may demonstrate chronic adaptive changes during alterations in hip biomechanics as the femoral head displaces.
  • AP radiograph: The Klein line is drawn straight up the superior aspect of the femoral neck. This should intersect the epiphysis. If not, then it is likely an SCFE (see the image below). A Klein line is a line drawn along the superior boA 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.
  • Frog leg radiograph: A straight line through the center of the femoral neck proximally should be at the center of the epiphysis. If not, and the line is anterior in the epiphysis, it is likely an SCFE.
  • Assess radiographs for signs of underlying medical disorders (rickets, renal osteodystrophy, etc).

Bone scanning, magnetic resonance imaging (MRI),[22] and computed tomography (CT) scanning are not routinely performed, but these imaging modalities may be helpful to confirm the diagnosis of SCFE or more accurately measure the degree of displacement and epiphyseal perfusion.

  • A report by Tins et al suggests that pretreatment MRI in established cases of SCFE has a role with prognostic implications for the treatment approach and outcome of this condition.[23] The investigators noted that synovitis, periphyseal edema, and joint effusion are regular features of SCFE; however, "the clinical history and findings are unreliable for the classification of SCFE," and "radiographs underestimate the severity of SCFE." On the other hand, Tins et al stated that "MRI can potentially identify unstable, reducible slips. If the mode of surgical treatment depends on the particular nature of the SCFE, then MRI contributes to surgical decision-making."[23]
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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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