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HIGH-YIELD FACTS

  • Classic presentation of slipped capital femoral epiphysis (SCFE) is that of an obese adolescent with nonradiating, dull pain in the hip, groin, thigh, or knee without a history of trauma.

  • Patients with SCFE may also present with isolated thigh or knee pain.

  • The traditional classification of SCFE is based on intensity and duration of symptoms into four patterns of presentation: pre-slip, acute, acute on chronic, and chronic.

  • The diagnosis is usually made on plain radiographs that typically display an apparent posterior displacement of the femoral epiphysis, like ice cream slipping off a cone. Imaging requires both lateral and AP views of the hip.

  • The treatment is operative and the goals are to prevent further slipping by stabilizing the diseased physis and preventing further growth complications.

  • The prognosis of SCFE is related to the severity of the slip as well as the etiology.

SCFE is characterized by a displacement of the capital femoral epiphysis from the femoral neck through the physeal plate. Sometimes also termed slipped upper femoral epiphysis (SUFE) or physiolysis of the hip, it is one of the most common hip disorders of adolescence, with an overall incidence of 10.8 per 100,000.1 The average age at the time of diagnosis is 11 to 12 years for girls and 12 to 13.5 years for boys.1–4 SCFE is more common in males than females, with a ratio of approximately 1.5 to 1, and is more frequent in African Americans and Hispanics.1,3 Obesity is a significant risk factor in the development of SCFE, as approximately one-half of children who acquire an SCFE have weights at or above the 95th percentile.5,6 The incidence is increasing with the increasing prevalence of obesity in adolescents.5,7 About 10% to 20% of children have bilateral slippage at presentation, and another 10% to 20% of patients who present with unilateral disease are diagnosed with a contralateral slip during adolescence.8,9 Contralateral hip slippage can even be diagnosed after the adolescent period. Among patients with known endocrinopathies, up to 100% can eventually develop bilateral slippage.10

DIAGNOSIS

The two most common features of the presentation of SCFE are pain and altered gait. The classic presentation is that of an obese adolescent without other risk factors and a complaint of nonradiating, dull, aching pain in the hip, groin, thigh, or knee without a history of trauma. However, 15% of patients present with isolated thigh or knee pain.11 Symptoms are generally worse with physical activity and relieved by rest, and may be acute, chronic, or intermittent. SCFE is more likely to be missed at the initial visit if hip pain is absent or thigh pain is present. Table 110-1 summarizes important differential diagnoses to consider for children presenting with hip pain.

TABLE 110-1Differential Diagnosis of Hip Pain in Children

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