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Slipped Capital Femoral Epiphysis

Slipped Capital Femoral Epiphysis (SCFE) is a condition of the hip caused by a fracture through the physis of the proximal femur. It affects primarily adolescent males and is closely associated with obesity. With the recent rise in childhood obesity rates, the incidence of SCFE has risen dramatically as well. Prompt recognition and treatment of this pathology can improve overall outcome and decrease complications such as avascular necrosis.

Adolescents with this condition may complain of distal thigh or knee pain or a painful limp. Ability to bear weight, location, and duration of symptoms are all important factors for prognosis. Often, by the time the patient is unable to bear weight, they have had a prodrome of increasing limp for days to weeks or previous episodes of pain. Diagnosis can be made on the basis of history, clinical exam, and radiographs. The fracture through the physis causes the femoral head to be displaced posteriorly and inferiorly in relation to the femoral neck. This finding can be most easily seen on a frog-leg lateral view of the hip. Adolescents diagnosed with SCFE should be sent to the emergency room immediately so that surgical treatment can proceed in a timely manner. In-situ percutaneous pinning of the hip is the treatment of choice in most cases. The goal is treatment is to prevent further slippage of the epiphysis. Rarely, SCFE can present in younger children, and this is usually related to renal osteodystrophy, endocrine abnormalities, or a history of radiation therapy.

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