Slipped Capital Femoral Epiphysis

13 y/o African American male with h/o obesity presents with deep hip pain while weight-bearing. Physical exam reveals antalgic gait with external foot rotation. Pain with log roll and straight leg raise against resistance. Pain with hip internal rotation relieved by external rotation.

• Radiography shows posterior displacement of femur under epiphysis and through the epiphyseal (growth) plate

• Refer to orthopedics

• Patient and parents counseled that risk for avascular necrosis is 30% if not appropriately treated

Notes

• Epidemiology

  • Most common in children ages 11-16 years

  • Risk factors: African American ethnicity, Male sex, obesity, physical activity

• Pathophysiology: Femoral head displaced posteriorly through growth plate

• Presentation

  • Pain generally anterior and within proximal third of thigh

  • Up to 33% of patients present with referred lower thigh or knee pain