From the Guidelines
Slipped capital femoral epiphysis (SCFE) typically presents with gradual onset of hip, groin, thigh, or knee pain and limping in overweight children aged 10-16, more commonly boys. The classic presentation includes:
- Limping or difficulty walking
- Pain in the hip, groin, thigh, or knee (often referred pain)
- Outward rotation of the affected leg
- Limited hip motion, especially internal rotation As noted in a study on severe obesity in children and adolescents 1, severely obese children are more likely to develop SCFE, which is a displacement of the femoral head from the femoral neck through the growth plate. This condition is often exacerbated by obesity, and hormonal factors may also play a role. Diagnosis is made through X-rays, and early recognition is crucial to prevent further slippage and complications. Treatment usually involves surgical fixation with screws to stabilize the femoral head. If SCFE is suspected, the child should be non-weight bearing and urgently referred to an orthopedic surgeon for evaluation and management. Prompt diagnosis and treatment are essential to prevent long-term hip problems and osteoarthritis.
From the Research
Typical Presentation of Slipped Capital Femoral Epiphysis (SCFE) in Children
- SCFE is a condition that commonly affects adolescents, but it can also occur in children under the age of 10, especially those who are overweight or obese 2, 3.
- The typical presentation of SCFE in children includes limping and poorly localized pain in the hip, groin, thigh, or knee 4, 5.
- The condition is often associated with obesity, growth spurts, and endocrine abnormalities such as hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism 4, 5.
- Diagnosis is confirmed by bilateral hip radiography, which should include anteroposterior and frog-leg views in patients with stable SCFE, and anteroposterior and cross-table lateral views in unstable SCFE 4, 5.
Key Characteristics of SCFE in Children
- The mean age at presentation for SCFE in children under 10 years old is around 8-9 years old 2, 3.
- The majority of children with SCFE are overweight or obese, with a high body mass index (BMI) for their age 2, 3.
- SCFE can be classified as stable or unstable based on the stability of the physis, with stable SCFE being more common in children under 10 years old 2, 3.
- The condition can be bilateral, with some children experiencing slips in both hips 3.
Importance of Early Diagnosis and Treatment
- Early diagnosis and treatment of SCFE are crucial to prevent slip progression and avoid complications such as avascular necrosis, chondrolysis, and femoroacetabular impingement 4, 6.
- In situ screw fixation is a common treatment method for stable SCFE, while unstable SCFE may require more complex treatment, including reduction and fixation 4, 5.
- Prophylactic fixation of the contralateral hip may be recommended in some cases to prevent future slips 3, 6.