Pediatric emergency medicine trisk 3967 3967
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FIGURE 121.14 Slipped capital femoral epiphysis of right hip. Epiphysis is displaced medially
on the frog view.
The degree of slippage is expressed with a grading system: grade I or preslip
with possible widening of the physis but no displacement, grade II with
displacement less than one-third of the width of the metaphysis, grade III with
displacement of one-third to half of the metaphyseal width, and grade IV with
displacement of greater than half the metaphyseal width.
Management/Indications for Discharge or Admission
Children with SCFE who present with severe symptoms and/or acute onset
should be admitted and promptly evaluated by an orthopedic surgeon. Unstable
SCFE is complicated by avascular necrosis of the femoral head in up to 20% of
cases. Patients with milder symptoms may be discharged on crutches, after timely
orthopedic follow-up has been arranged. Treatment of SCFE is primarily surgical.
Chondrolysis, the most common complication of SCFE, occurs in about 8% of
patients. Pain and persistent decreased range of motion after pinning are the usual
presenting symptoms. If the pins extend into the joint space, the risk of
chondrolysis is increased. Two-thirds of patients with chondrolysis have a
progressive course. Ankylosis may ensue, leading to long-term disability. With a
15% risk of subsequent slippage of the contralateral hip, prophylactic pinning of
the contralateral hip after unilateral SCFE is controversial. Younger chronologic
