Slipped Capital Femoral Epiphysis (SCFE)
The diagnosis is slipped capital femoral epiphysis (SCFE), a serious hip pathology that must be excluded first in any adolescent presenting with hip pain, external rotation deformity, decreased range of motion, and antalgic gait. 1, 2
Clinical Presentation Matches SCFE
The classic triad presented by this patient is pathognomonic for SCFE:
- Hip held in external rotation - This is the hallmark deformity of SCFE as the femoral head slips posteriorly and inferiorly through the growth plate, causing obligate external rotation positioning 3
- Decreased hip range of motion - Particularly limited internal rotation, which is characteristic of SCFE 3
- Antalgic gait - Results from pain and mechanical derangement of the hip joint 3
- Groin and hip pain for one month - SCFE commonly presents with insidious onset pain that may have been present for months before diagnosis 3
Why SCFE Must Be Diagnosed First
The British Journal of Sports Medicine guidelines explicitly state that SCFE is a "serious hip pathological condition" that must be excluded before considering other diagnoses like femoroacetabular impingement syndrome, labral tears, or acetabular dysplasia in young patients with hip pain. 1, 2
- SCFE is the most prevalent hip disease in adolescents, making it the primary consideration in a 13-year-old with these symptoms 3
- The later SCFE is diagnosed and treated, the greater the chance of premature osteoarthritis 3
- Delayed diagnosis increases risk of serious complications including avascular necrosis and chondrolysis 3
Age and Demographics Support SCFE
- Peak incidence occurs during adolescent growth spurt - This patient's age of 13 years falls within the typical range 3
- SCFE can present as hip, groin, thigh, or even isolated knee pain, which can delay diagnosis if not considered 4, 5
Immediate Next Steps
Plain radiographs are required immediately - AP pelvis and frog-leg lateral views will demonstrate the femoral head displacement through the growth plate 4, 5
- If SCFE is confirmed, urgent orthopedic referral for in situ fixation with screws is indicated to prevent further slippage and complications 3
- The external rotation deformity and antalgic gait typically resolve following surgical fixation 3
Critical Pitfall to Avoid
Do not attribute this presentation to more common athletic hip conditions (FAI syndrome, labral tears) without first excluding SCFE with radiographs. 1, 2 The guidelines emphasize that serious pathology like SCFE must be ruled out before diagnosing other hip-related pain conditions in young patients, as missing this diagnosis leads to progressive deformity and poor long-term outcomes 1, 3