In slipped capital femoral epiphysis the ball of the hip slips off the femoral neck through the growth plate, usually in overweight children aged 10 to 16. The pain can show up only in the knee, so the hip must be examined in any limping teen.
Key symptoms
- Limp and pain in the hip, groin, thigh or knee
- Pain for weeks to months, or sudden after a minor fall
- Unable to bear weight in an unstable slip
- Leg turned outward when walking
What you find on exam
- Loss of internal rotation of the hip
- Hip rolls into external rotation when flexed (obligate external rotation)
- Limping or out-toeing gait; the leg may look shorter
- Check the other hip, which is often involved
Tests
- AP and frog-leg lateral X-rays of both hips
- Klein line does not cross the femoral head
- Thyroid and other endocrine tests if the age or body build is atypical
Treatment basics
- No weight bearing, crutches right away
- Urgent orthopedic referral
- Surgical fixation with a screw across the growth plate (in situ pinning)
- Consider fixing the other hip in high risk children
Red flags
- Cannot bear weight at all, a sign of an unstable slip
- Teen with knee pain and a normal knee exam
- Sudden worsening of pain, which raises the risk of avascular necrosis of the femoral head
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.