Slipped Capital Femoral Epiphysitis (SCFE) can be a challenge to diagnose and manage.
Features of SCFE:
(1) It occurs in children 10-13 years of age during the period of active growth.
(2) It presents with pain or discomfort in the hip, thighs or knees.
(3) The patient develops a limp.
(4) The range of motion of the hip joint is restricted with limitations in flexion and internal rotation.
(5) Drehmann's sign (passive flexion of the hip results in abduction and external rotation of the hip joint)
(6) The contralateral side may be affected months later.
Imaging findings:
(1) There is widening and irregularity of the physeal line.
(2) Trethowan sign (failure of Klein's line to transect the physeal region; Klein's line is a line extending along the superior surface of the femoral neck)
Factors that can result in a delay in diagnosis:
(1) Pain may be mild.
(2) Knee symptoms may dominate.
(3) Evaluation by a clinician other than an orthopedic surgeon.
(4) Failure to perform a complete exam with the child supine.
(5) Failure to adequately visualize the femoral head and neck in imaging studies.
