Slideshow
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Figure 1. Anteroposterior radiograph of the pelvis.
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Figure 2. Lateral radiograph of the pelvis.
Slipped Capital Femoral Epiphysis (SCFE)
An 11-year-old girl presents with her parents complaining of severe right hip pain and difficulty walking. She denies having a known injury and the pain has progressively increased over the past 4 weeks. She is healthy and active with no underlying medical conditions. On physical examination, she has pain with hip motion but no obvious skin changes or deformity. Pelvis imaging is obtained (Figures 1 and 2).
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The patient is presenting with a chronic slipped capital femoral epiphysis (SCFE). Chronic SCFE is defined as symptoms of pain in the groin, thigh, or knee lasting more than 3 weeks.1 Chronic SCFE is by far the most common form of this condition, accounting for 85% of all patients who present with SCFE.1
The stability of SCFE is based on the patient’s ability to bear weight. If the patient can’t put any weight on the leg, the SCFE is designated as unstable. By contrast, the ability to weight bear represents a stable SCFE pattern.1
Because the patient in this case was able to walk into the clinic, although with pain, her SCFE would be classified as stable. The patient’s radiographs show a grade I mild slip, which appears chronic. The duration of symptoms and the patient’s difficulty with bearing weight both indicate that the SCFE has not healed.
Magnetic resonance imaging has a role in diagnosing early pre-slip SCFE in the presence of normal radiographs. However, this patient has growth plate changes noted. The treatment of choice for stable and unstable SCFE is placement of single- or double-screw fixation to prevent further slippage of the growth plate. Unstable and severe slips may require open reduction of the growth plate with fixation.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
References
1. Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg. 2006;14(12):666-679. doi:10.5435/00124635-200611000-00010
2. Wylie JD, Novais EN. Evolving understanding of and treatment approaches to slipped capital femoral epiphysis. Curr Rev Musculoskelet Med. 2019;12(2):213-219. doi:10.1007/s12178-019-09547-5
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