Pediatric emergency medicine trisk 3964 3964
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Early surgical fixation of the epiphysis prevents further slippage and improves
functional outcome.
CLINICAL PEARLS AND PITFALLS
Acute (unstable) SCFE is associated with a higher rate of avascular
necrosis than chronic (stable) SCFE.
AP and frog-leg radiographs are the imaging studies of choice for
SCFE though ultrasound and MRI are playing an increasing role.
SCFE typically occurs during the adolescent growth spurt.
Obesity is a significant risk factor for SCFE.
Presence of referred pain to the groin, thigh, or knee is common and
may result in delayed diagnosis.
Limited internal hip rotation and pain with external rotation are signs
that suggest SCFE.
Bilateral SCFE occurs in 25% of cases and may not be detectable at
the time of initial diagnosis.
Presence of an endocrinopathy, commonly hypothyroidism, should be
suspected in children with SCFE who are outside the normal age
range.
Current Evidence
SCFE is the most common hip disorder in adolescent patients and should be
familiar to all who care for children in this age group. It is twice as common in
males than in females, and more common in African-American patients. Over
80% of patients with SCFE have body mass index above the 95th percentile, but
clinicians must also consider SCFE in patients who are not obese to avoid
delayed diagnosis. Most children with SCFE are early adolescents in their growth
spurt. Boys are most commonly affected between 12 and 14 years of age, and
girls between 10 and 12 years of age because of their earlier pubertal
development. SCFE onset after menarche is extremely rare.
Slippage of capital femoral epiphysis is almost always posterior and inferior
relative to the proximal femoral metaphysis, however, displacement anteriorly or
superiorly has been reported. The epiphysis maintains a normal relationship with
the acetabulum. Although symptoms are usually unilateral, plain radiographs
document bilateral slippage in about 25% of cases, and computed tomographic
(CT) scans and MRI in up to 50%.
