Slipped Capital Femoral Epiphysis

Case 15: A 12-year-old overweight male presents with four weeks of an intermittent left leg limp. He denies an injury but remembers landing from catching a ball and having some pain. He points to the groin and thigh area and says he has pain with prolonged running and walking but no pain at rest or at night. He walks with a slight limp and has pain and mild limitation with internal rotation and abduction of the hip.

A slipped capital femoral epiphysis (SCFE) is an orthopedic emergency. Typically seen in overweight adolescents ages 11 to 15, SCFEs present with hip, thigh, or knee pain and a limp that may be unilateral or bilateral. Pain may be acute or more chronic in nature. Adolescents may

Table 2 Common Adolescent Pelvic Apophyseal Injuries

Age at

apophyseal

Muscle

Apophysis

ossification

attachments

Mechanism

Physical exam findings

Sports

Iliac crest

18-21

Abdominals,

Abdominal contraction with

Pain with abdominal

Running

gluteus

contraction of gluteals; sudden

contraction and resisted

Hockey

maximus

change of direction while running

hip abduction

Football

Anterior superior

21-25

Sartorius

Contraction of sartorius with hip

Pain with passive hip

Hurdlers

iliac spine

extended and knee flexed

extension; active hip flexion

Jumpers Sprinters

Ischial tuberosity

18-21

Hamstrings

Hamstring contraction with hip flexed and knee extended

Pain with resisted hip extension or passive hip flexion; difficulty sitting

Hurdlers Jumpers Sprinters

Anterior inferior

16-18

Rectus

Contraction of rectus femoris with

Pain with passive hip

Sprinting

iliac spine

femoris

kicking

extension; active hip flexion

Kicking

Source: Adapted from Ref. 13.

Source: Adapted from Ref. 13.

Figure 12 Avulsion injury of the anterior superior iliac spine.

walk with a limp with the affected leg in an externally rotated position. They may have limited internal rotation or abduction and have pain with hip movement. Some will have obligatory external rotation of the hip with flexion of the knee. AP and frog view of the hips show slippage of the epiphysis (Fig. 13). SCFEs need immediate surgical management to prevent further slippage and damage of the hip joint. Adolescents should be made non-weightbearing on crutches and sent for immediate orthopedic evaluation.

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