From the Guidelines
Slipped capital femoral epiphysis (SCFE) typically presents with hip or knee pain, limping, and decreased range of motion in the affected hip, and can be classified as stable or unstable based on the patient's ability to bear weight. The classic presentation of SCFE includes pain localized to the groin, anterior thigh, or knee, with knee pain often being the primary complaint, leading to delayed diagnosis 1. Physical examination reveals limited internal rotation, abduction, and flexion of the hip, with obligatory external rotation when the hip is flexed. Patients may demonstrate an antalgic gait or refuse to bear weight on the affected limb. Some key points to consider in the presentation of SCFE include:
- Risk factors such as obesity, which is a significant risk factor for SCFE, especially in severely obese children who are more likely to develop bilateral slipped capital femoral epiphysis 1
- The importance of early recognition, as delayed diagnosis can lead to progression of slip severity and increased complications including avascular necrosis, chondrolysis, and early osteoarthritis
- The need to exclude other hip-related conditions, such as femoroacetabular impingement syndrome, acetabular dysplasia, and labral, chondral, and ligamentum teres conditions, when diagnosing hip-related pain in young and middle-aged active adults 1. However, it is essential to prioritize the most critical aspect of SCFE, which is early recognition and classification as stable or unstable to prevent complications and improve outcomes. In terms of specific details, the condition may also be categorized by chronicity as acute (symptoms less than 3 weeks), chronic (symptoms more than 3 weeks), or acute-on-chronic, and radiographic findings include widening of the physis and posterior displacement of the femoral head relative to the neck on lateral views. Overall, the key to managing SCFE is prompt diagnosis and treatment to prevent long-term morbidity and mortality.
From the Research
Presentations of Slipped Capital Femoral Epiphysis (SCFE)
The presentations of SCFE include:
- Limping and poorly localized pain in the hip, groin, thigh, or knee 2, 3, 4
- Vague pain in the hip, thigh, or knee 3
- Referred pain from pathology at the hip, which may present as knee pain 3
- Out-toeing, decreased internal rotation, or obligate external rotation with flexion 3
- "Groin pull", although this is exceedingly rare in children and should be a diagnosis of exclusion 3
Common Complaints
Common complaints among adolescents with SCFE include:
- Hip pain
- Thigh pain
- Knee pain
- Limping
Importance of Early Diagnosis
Early diagnosis is crucial to prevent delay in diagnosis, which can lead to opportunities for progression of deformity, increased risk of arthritis, and development of avascular necrosis (AVN) 3, 5