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Updated: Dec 22 2021

Slipped Capital Femoral Epiphysis

Images hip.jpg
  • Snapshot
    • A 13-year-old boy presents with pain in his left groin, hip, and thigh. His mother notices a limp when he walks. The patient denies any recent significant trauma to his left lower extremity. On physical exam, his gait is antalgic. With the patient in the supine position, there is external rotation and abduction of the thigh with passive flexion of the hip. A radiograph of the affected hip is performed, which demonstrates inferior displacement of the left epiphysis.
  • Introduction
    • Clinical definition
      • a hip disorder common in adolescents in which the head of the femur slips off the neck of the femur inferiorly and posteriorly, often due to mechanical overload
  • Etiology
    • Pathogenesis
      • unstable growth plate (femoral physis) from
        • mechanical overload causing excessive shear force on the growth plate
        • growth spurts causing rapid cellular proliferation in growth plate
        • change in vasculature resulting in suboptimal blood supply to the growth plate
      • unstable growth plate can cause slippage of the femoral epiphysis
    • Associated conditions
      • endocrine disorders affecting bone metabolism
        • hypothyroidism (most common)
        • growth hormone deficiency
        • multiple endocrine neoplasia
      • Down syndrome
      • renal osteodystrophy
  • Epidemiology
    • Demographics
      • male > female
      • children and adolescents 8-16 years of age
      • more common in black and Hispanic children
    • Risk factors
      • obesity
      • growth spurt
  • Presentation
    • Symptoms
      • pain in the groin, hip, thigh, or ipsilateral knee without inciting trauma
      • painful limp
    • Physical exam
      • Drehmann sign
        • while in the supine position, hip externally rotates and abducts with passive hip flexion
      • antalgic or waddling gait
      • externally rotated leg on the affected side
      • inability to bear weight
      • limited range of motion of the hip
  • Imaging
    • Radiography
      • indication
        • for all patients to confirm diagnosis and grade severity
      • recommend view
        • anteroposterior and frog-leg lateral
      • findings
        • widening of joint space
        • decrease in epiphyseal height
        • Steel sign
          • double density from superimposition of epiphysis and metaphysis
  • Studies
    • Making the diagnosis
      • most cases are clinically diagnosed and confirmed with radiography
  • Differential
    • Legg-Calve-Perthes disease
      • distinguishing factor
        • in younger children with radiography showing joint effusions and increased width of the femoral neck
        • not treated with surgery
  • Treatment
    • Conservative
      • non-weight-bearing clutches or wheelchair
        • indication
          • for all patients while awaiting surgery
    • Operative
      • surgical fixation with screw
        • indication
          • for all patients
      • prophylactic screw fixation of contralateral hip
        • indications
          • may be considered for patients, as there is a risk of the disease in contralateral hip later in life
          • usually for patients < 10 or > 16 years of age
  • Complications
    • Avascular necrosis of hip
    • Chondrolysis
      • loss of joint cartilage
    • Osteoarthritis
  • Prognosis
    • May recur even with stabilization
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