From the Guidelines
Slipped capital femoral epiphysis (SCFE) is a hip disorder that requires immediate orthopedic consultation and surgical intervention with in situ pinning to stabilize the femoral head and prevent further slippage, as it can lead to severe complications such as avascular necrosis, chondrolysis, and early osteoarthritis if left untreated 1.
Diagnosis and Treatment
The diagnosis of SCFE is typically made through a combination of clinical examination, medical history, and imaging studies such as X-rays or MRI. It is essential to exclude other non-musculoskeletal and serious hip pathological conditions, such as tumors, infections, stress fractures, as well as competing musculoskeletal conditions like lumbar spine issues 1.
Key Considerations
- The affected leg should not bear weight until surgery is performed to prevent further slippage and complications.
- Post-surgery, patients typically use crutches for 6-8 weeks with gradual return to activities as directed by the orthopedic surgeon.
- Long-term follow-up is essential to monitor for potential complications and address any associated endocrine disorders like hypothyroidism or growth hormone deficiency.
- Early diagnosis is crucial to prevent severe slippage and complications, so any adolescent with unexplained hip, knee, or thigh pain should be evaluated promptly, as pain may be referred and not localized to the hip.
Important Notes
- Clinical examination and diagnostic imaging have limited diagnostic utility, and a comprehensive approach is therefore essential 1.
- A negative flexion–adduction–internal rotation test can help rule out hip-related pain, although its clinical utility is limited 1.
From the Research
Diagnosis of Slipped Capital Femoral Epiphysis (SCFE)
- SCFE is diagnosed using 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 2, 3.
- The condition is classified as stable or unstable based on the stability of the physis 2, 3.
- Patients with SCFE usually present with limping and poorly localized pain in the hip, groin, thigh, or knee 2, 3.
Treatment of Stable SCFE
- Stable SCFE is usually treated using in situ screw fixation 4, 2, 3.
- The goal of treatment is to prevent slip progression and avoid complications such as avascular necrosis, chondrolysis, and femoroacetabular impingement 2.
Treatment of Unstable SCFE
- Treatment of unstable SCFE usually involves in situ fixation, but there is controversy about the timing of surgery and the value of reduction 5, 2, 3.
- Controlled repositioning and primary osteoplasty is a viable treatment option for a subset of patients with unstable SCFEs 5.
- Techniques for managing the resulting proximal femoral deformity include arthroscopic femoral neck osteochondroplasty, a limited anterior hip approach or surgical hip dislocation, and flexion intertrochanteric osteotomy 4.