Slipped Capital Femoral Epiphysis Surgery Clinical Presentation

Updated: Aug 06, 2021
  • Author: Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho; Chief Editor: William L Jaffe, MD  more...
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Presentation

History

Patients with slipped capital femoral epiphysis (SCFE) may present with the following symptoms:

  • Pain - The presenting feature is hip (groin) pain in most patients; as many as 46% of patients with chronic slips may present with thigh pain or knee pain (eg, referred pain, obturator nerve)
  • Limp
  • Inability to bear weight in acute slips
  • History of irradiation, renal failure, endocrinopathy (eg, hypothyroidism and treatment thereof, acromegaly, short stature [growth hormone supplementation])

Either side may be affected. The left hip is involved in 60% of unilateral cases. In most studies, 18-50% of cases are bilateral, though some studies have reported the prevalence of bilaterality to be as high as 80%. [39, 40, 41]  Bilateral involvement may be evident at the time of initial presentation. [20]  Most patients who subsequently develop a contralateral slip do so within 18-24 months of initial symptoms, though slips may occur until physeal closure. [20, 25, 39, 42, 43, 44, 45]

Management of the patient who presents with unilateral involvement is controversial. Significant morbidity can occur if the other side slips and displaces. Early recognition of a preslip on the contralateral side would help determine which patients are at greater risk. A scoring system has been developed to predict the risk of a contralateral slip. [46]

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Physical Examination

The following physical signs may be present:

  • Externally rotated attitude of the affected lower limb
  • In varus slips, restriction of flexion, abduction, and internal rotation of the affected hip
  • In valgus slips, restriction of flexion, adduction, and internal rotation
  • Obligatory external rotation on flexion (this is a diagnostic clue)
  • In chronic slips, wasting of the thigh
  • True supratrochanteric shortening (Bryant triangle, Nélaton line)
  • Trendelenburg sign and gait possible; antalgic gait in acute or acute-on-chronic slips

Typically, knee examination and radiographic findings are normal in individuals with SCFE. All children with knee pain should have their hips evaluated.

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