Slipped Capital Femoral Epiphysis (SCFE)
Slipped Capital Femoral Epiphysis (SCFE)
SCFE is a common hip disorder in adolescents characterized by displacement of the proximal femoral epiphysis relative to the metaphysis through the physis (growth plate).
Key Points
- Most common hip disorder in adolescents
- Peak age: 10-16 years
- Bilateral in 20-40% of cases
- More common in males (male:female ratio 1.5:1)
- Associated with obesity and endocrine disorders
Associated Conditions
- Endocrine disorders:
- Hypothyroidism
- Growth hormone deficiency
- Hypogonadism
- Panhypopituitarism
- Metabolic conditions:
- Obesity (most common)
- Renal osteodystrophy
Demographics
- Incidence: 2-13/100,000 children
- Age range: 8-15 years
- Mean age:
- Boys: 13.5 years
- Girls: 12.0 years
- Racial predisposition:
- Higher in Pacific Islanders
- Higher in African Americans
Risk Factors
- Obesity (>95th percentile)
- Rapid growth during puberty
- Family history
- Endocrine disorders
- Male gender
- African American race
Temporal Classification
- Pre-slip: Early changes without displacement
- Acute: Symptoms <3 weeks
- Chronic: Symptoms >3 weeks
- Acute-on-chronic: Acute symptoms in chronic SCFE
Stability Classification (Loder)
- Stable SCFE:
- Can bear weight with or without crutches
- Better prognosis
- 85% of cases
- Unstable SCFE:
- Cannot bear weight even with crutches
- Higher risk of avascular necrosis
- 15% of cases
Southwick Angle Classification
- Mild: <30°
- Moderate: 30-50°
- Severe: >50°
Symptoms
- Pain:
- Hip pain (most common)
- Knee pain (33% cases)
- Thigh pain
- Limping
- Decreased range of motion
- External rotation when hip is flexed
Physical Examination
- Obligatory external rotation with hip flexion
- Limited internal rotation
- Trendelenburg gait
- Drehmann sign: Passive hip flexion causes automatic external rotation
- Wilson test often positive
Imaging Studies
- X-rays (standard):
- AP pelvis view
- Frog-leg lateral view (stable SCFE only)
- Cross-table lateral view
- Klein's line abnormality
- Metaphyseal blanch sign
- MRI: Pre-slip detection
Laboratory Studies
- Endocrine workup if indicated:
- TSH, Free T4
- Growth hormone levels
- FSH, LH
Initial Management
- Non-weight bearing
- Urgent orthopedic consultation
- Pain management
Surgical Management
- Stable SCFE:
- In-situ pinning
- Single cannulated screw fixation
- Unstable SCFE:
- Urgent stabilization
- Modified Dunn procedure
- Consideration for surgical hip dislocation
Prophylactic Pinning
- Consider in:
- Contralateral hip in young patients
- Endocrine disorders
- Young age at presentation
Early Complications
- Avascular necrosis (most severe)
- Chondrolysis
- Hardware problems
- Infection
Late Complications
- Femoroacetabular impingement
- Early osteoarthritis
- Leg length discrepancy
- Contralateral SCFE (20-40%)
Prognostic Factors
- Better prognosis:
- Stable slips
- Mild displacement
- Early diagnosis
- Poor prognosis:
- Unstable slips
- Severe displacement
- Development of AVN
Long-term Outcomes
- Risk of early osteoarthritis
- Need for long-term follow-up
- Possible need for total hip arthroplasty in adulthood
