MSK - Slipped femoral epiphysis

Question 1

Definition

Answer 1

Also known as slipped capital femoral epiphysis (SCFE) = It is where the head of the femur is displaced (“slips”) along the growth plate.

Question 2

Epidemiology

Answer 2

• Boys
• Typically presents aged 8 – 15 years = with the average age of 12 in boys.
  = It presents slightly earlier in females, with an average age of 11 years.
• It is more common in obese children.

Question 3

Signs and symptoms

Answer 3

Presenting symptoms can be vague. These can be:
- Hip, groin, thigh or knee pain
- Restricted range of hip movement
- Painful limp

When examining the patient, they will prefer to keep the hip in external rotation. They will have limited movement of the hip, particularly restricted internal rotation on leg flexion

Question 4

Typical presentation

Answer 4

The typical exam presentation is an adolescent, obese male undergoing a growth spurt. There may be a history of minor trauma that triggers the onset of symptoms. Suspect SUFE if the pain is disproportionate to the severity of the trauma.

Question 5

Diagnosis

Answer 5

FIRST LINE = X-ray = AP and lateral (typically frog-leg) views are diagnostic
- Blood tests are normal, particularly inflammatory markers used to exclude other causes of joint pain
- Technetium bone scan
- CT scan
- MRI scan

Question 6

Treatment

Answer 6

Surgery: Internal fixation: typically a single cannulated screw placed in the centre of the epiphysis

Question 7

Complications

Answer 7

osteoarthritis
avascular necrosis of the femoral head
chondrolysis
leg length discrepancy