Common Pediatric MSK Concerns


Slipped Capital Femoral Epiphysis of the left hip in a 14 year old male
Image source: L. Davidson

SCFE is a disorder of unknown etiology that affects children as they enter adolescence, typically ages 10-14 in girls, slightly older in boys.

The presentation is generally one of a chronically evolving limp with associated pain that can be felt in the groin, thigh or knee. The gait may be noted to be externally rotated on the affected side. Pain is generally worse with activity. Many patients with SCFE are overweight, however normal body weight does not exclude this diagnosis. There is an acute form of SCFE that presents suddenly with acute pain and difficulty weight bearing.

Radiographs in SCFE reveal malalignment of the upper femoral epihysis due to a mechanical failure at the level of the growth plate. The x-ray above demonstrates displacement of the epiphysis of the left hip, the normal right hip serves as comparison. Up to 40% of patients will eventually develop bilateral disease and so monitoring of the contralateral hip must continue until growth is complete. Over time, the upper portion of the femoral head displaces leading to abnormal anatomy of the hip joint that predisposes to premature osteoarthritis.

Treatment involves the surgical stablilization of the femoral epiphysis with a screw. This will prevent any further displacement and will hasten the fusion of the upper femoral growth plate. Early diagnosis is key to optimizing outcome in SCFE. Adolescents who present with a limp, groin/thigh or knee pain and an externally rotated, Trendelenburg gait should receive AP and frog xrays of the pelvis to rule out this disorder.

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Ice cream analogy: Normal 'hips'
Image source: L. Davidson
Right "SCFE"
Image source: L. Davidson