Slipped capital femoral epiphysis update

Abstract

Purpose of review: Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip condition. Its importance lies in its high morbidity if not diagnosed and treated in its early stages, not only in childhood but also as a cause of osteoarthritis in adulthood. This article highlights key diagnostic tools and optimal treatment plans for SCFE.

Recent findings: SCFE involves displacement between the proximal femoral neck and the femoral head at the level of the open physis, with biomechanical and biochemical factors implicated. Acute major trauma is rarely involved; a gradual onset of symptoms and deformity is more common. Patients with unstable SCFE are in severe pain and unable to bear weight. SCFE occasionally is associated with endocrine or metabolic abnormality (hypothyroidism, panhypopituitarism and renal rickets). On physical examination, limited internal rotation of the affected hip is usual; obligatory external rotation of hip in flexion is classic. Diagnosis is confirmed on anteroposterior and frog-leg lateral radiographs of both hips. Treatment is surgical, with stabilization across the physis by in-situ pinning being the gold standard.

Summary: Prompt diagnosis and timely surgical treatment usually lead to excellent long-term results with minimal morbidity. It is crucial to recognize that groin pulls are very rare in adolescents. Children with suggestive groin symptoms should have hip anteroposterior and frog-leg lateral radiographs to rule out the much more common SCFE.