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Virtual Pediatric Hospital: Paediapaedia: Slipped Capital Femoral Epiphysis (SCFE) Paediapaedia: Musculoskeletal Diseases

Slipped Capital Femoral Epiphysis (SCFE)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Seen in obese children in early adolescence, more common in males than females and more common in blacks than whites. Approximately 50% have hip pain and 25% have knee pain.

Etiology/Pathophysiology:
Is a shearing fracture of the proximal femoral growth plate with a subsequent epiphyseal slip. In reality it represents a Salter-Harris Type I fracture caused by chronic stress from the patient's obesity. The femoral head remains within the acetabulum while the femoral shaft is pulled laterally and anteriorly with external rotation so in reality it is the shaft that slips and not the femoral head. There is a history of previous injury in 50% of the patients and 20-30% are bilateral. Treated with stabilization via pinning. Late complications include avascular necrosis, articular chondrolysis, degenerative arthritis and various deformities of the femoral head and neck.

Pathology:
Not applicable

Imaging Findings:
On the frontal film generalized osteopenia of the hip along with widening of physis is all that may be seen. The lateral film is the best film to make the diagnosis on, it shows a smooth epiphyseal-metaphyseal junction. Later in the course the metaphyseal head can be seen undergoing resorption.

DDX:

References:
See References Chapter.

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