Overview
Also known as slipped upper femoral epiphysis (SUFE), slipped capital femoral epiphysis (SCFE) describes weakness through the proximal femoral physis (growth plate) that allows displacement of the metaphysis. It is classically seen in obese boys.
SCFE is a misnomer, as the epiphysis of the bone stays in place and it is the metaphysis that displaces anteriorly and superiorly, leading to a slipped state.
Epidemiology
- SCFE is most common in those aged 8-15 years old
- SCFE is more common in obese children and boys
- The left hip is more commonly affected than the right
Presentation
Symptoms can develop over weeks to months, but can occur acutely after trauma (e.g. while playing sports):
- Pain in the hip, groin, medial thigh, or knee
- A limp on the affected side
- Loss of internal rotation and abduction of the hip due to pain
- The affected hip may be held in flexion and external rotation
Investigations
Overview
- Anteroposterior (AP) and frog-leg lateral X-rays:
- Diagnostic
Management
Overview
The patient should not be allowed to walk and should avoid moving or rotating the leg. Surgery via internal fixation is performed.
Complications
- SCFE in the other hip
- Avascular necrosis of the epiphysis
- Chondrolysis – the destruction of articular cartilage with joint stiffness and pain
Prognosis
- The prognosis depends on the degree of epiphyseal slipping and how quickly SCFE is diagnosed and managed. As slippage increases, the risk of complications increases.
