Slipped Capital Femoral Epiphysis Workup

Updated: Dec 03, 2018
  • Author: Kevin D Walter, MD, FAAP; Chief Editor: Craig C Young, MD  more...
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Workup

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.

Next:

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 bo 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.
  • 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), [26] 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. [27] 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." [27]

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