Background
SCFE happens most commonly during the adolescent growth spurt (11-13 years of age for girls, and 13-15 years of age for boys).
Diagnosis
H&P
-DDx of hip pain/limping.
–Risk factors.
–Limited internal rotation of the flexed hip on physical exam is pathognomonic for SCFE.
-XR
-Consider Including CBC, CRP, ESR, CMP to r/o infection and get basic labs.
Treatment
-Non-weight bearing.
-Refer to orthopedic surgery as soon as the diagnosis is made.
Average age is 12 for females and 13.5 for males.
Some patients present with pain while others present with a painless limp or vague pain.
“Slipped capital femoral epiphysis (SCFE) typically occurs in young adolescents during the growth spurt, when the femoral head is displaced posteriorly through the growth plate. Physical activity, obesity, and male sex are predisposing factors for the development of this condition. There is pain with physical activity, most commonly in the upper thigh anteriorly, but one-third of patients present with referred lower thigh or knee pain, which can make accurate and timely diagnosis more difficult. The hallmark of SCFE on examination is limited internal rotation of the hip. Specific to SCFE is the even greater limitation of internal rotation when the hip is flexed to 90°. No other pediatric condition has this physical finding, which makes the maneuver very useful in children with lower extremity pain. Orthopedic consultation is advised if SCFE is suspected. Hip extension and abduction are also limited in SCFE, but these findings are nonspecific. Displacement of the patella is not associated with SCFE.” ABFM
Considering DDx
A lack of systemic symptoms like fever, chills, night sweats, weight loss, appetite changes makes osteomyelitis, abscess, or a septic joint much less likely.
Malignancy is usually associated with night pain.
Sacroiliitis is associated with a positive FABER test.
Transient synovitis or Legg-Calvé-Perthes will go down on the differential based on patient’s age alone.
Muscle strain is a possibility – Look for hx of trauma.
In some patients with SCFE, the right hip externally rotates involuntarily with passive flexion. Such finding, in addition to the pathognomonic decreased internal rotation, makes SCFE all the more likely.
References
Am Fam Physician 2009;79(3):215-224.
Am Fam Physician 2010;82(3):258-262.