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Diagnosis: Slipped Capital Femoral Epiphysis.

Discussion: Slipped capital femoral epiphysis (SCFE) is an entity which occurs during adolescence. It occurs typically between the ages of 10 and 17 in boys and 8 and 15 in girls. The incidence of SCFE coincides with the adolescent growth spurt but this is not the only association implicated. It is believed that trauma may play a role in the development of SCFE, especially in younger children. There are various horizontal influences which appear to be related, such as hypothyroidism, acromegaly, gigantism, as well as other pituitary and parathyroid causes. There is a higher incidence of SCFE in obese adolescents. The increased weight may cause an increase in shearing forces on the growth plate even during normal daily activity.

SCFE may be suspected in an adolescent with pain in the region of the hip or anterior thigh especially with internal or external rotation of the hip. The presence of obesity or an underlying endocrine disease, such as hypothyroidism should raise the clinical suspicion even further.

To diagnose a suspected SCFE, both an anteroposterior and frog-leg lateral radiographs are mandatory. In the anteroposterior views, a line drawn along the superior femoral neck should pass through the femoral head and the medial contour of the head and neck should describe a pass through the femoral head and the medial contour of the head and neck should describe a continuous arc. With early slipping, the epiphyseal plate will be widened and the epiphysis will appear somewhat shortened on the affected side. The margin of the metaphysis may appear indistinct. On the frog-leg lateral view, the degree of posterior epiphyseal displacement is generally easily seen while often still not apparent on the AP view.

Chronic changes of SCFE include periosteal proliferation at the inferior and posterior juxta-epiphyseal margins of the neck secondary to buttressing of the changing stresses due to the slippage. In addition, there may be premature fusion of the growth plate which will result in femoral shortening. Other sequaelae of SCFE include osteonecrosis, chondrolysis, and degenerative joint disease.

Modality: CT

References:
Klein, Armin, et al. Roentgenographic features of slipped capital femoral epiphysis.
AJR 1951;66:361-373.

Resnick D. Bone and Joint Imaging. Philadelphia, PA: W. B. Saunders Co., 1989.

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