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paediatric

Slipped Capital Femoral Epiphysis (SCFE)

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 13-year-old obese boy presents with a 4-week history of right hip pain and limp. The pain radiates to his knee. He has no history of trauma. He is Tanner stage 2. On examination, he has an antalgic gait and holds his right leg in external rotation. Hip flexion causes obligate external rotation. Internal rotation is severely limited to 5 degrees.
AP pelvis radiograph demonstrating left SCFE. Klein's line drawn along the superior femoral neck fails to intersect the femoral epiphysis (abnormal - should intersect lateral third). Widening of the physis is visible. Frog-leg lateral view shows the characteristic posterior and inferior slip of the epiphysis relative to the metaphysis. The Southwick slip angle measures 35 degrees indicating moderate slip severity.
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AP pelvis radiograph demonstrating left SCFE. Klein's line drawn along the superior femoral neck fails to intersect the femoral epiphysis (abnormal - should intersect lateral third). Widening of the physis is visible. Frog-leg lateral view shows the characteristic posterior and inferior slip of the epiphysis relative to the metaphysis. The Southwick slip angle measures 35 degrees indicating moderate slip severity.

Source: SCFE Radiograph (Management Survey - EPOS) • PMC3221762 • CC-BY

Questions

Question 1 (4 marks)

Describe the clinical presentation and examination findings typical of SCFE.

Question 2 (5 marks)

Interpret the radiographs and explain the classification systems used.

Question 3 (6 marks)

What is the pathophysiology and who are the at-risk populations?

Question 4 (5 marks)

Describe the surgical technique for in-situ pinning.

Question 5 (4 marks)

What are the complications of SCFE and its treatment?

Question 6 (4 marks)

Discuss prophylactic pinning of the contralateral hip.

Exam Day Cheat Sheet

Must Mention

  • •Loder: Stable (WB, <5% AVN) vs Unstable (no WB, 50% AVN)
  • •Southwick: Mild <30°, Moderate 30-60°, Severe >60°
  • •Obligate external rotation is pathognomonic
  • •Klein's line doesn't intersect epiphysis
  • •In-situ pinning WITHOUT reduction
  • •Knee pain in obese adolescent = SCFE until proven otherwise

Common Pitfalls

  • •Reducing stable SCFE
  • •Missing knee referral
  • •Wrong angle thresholds
  • •Joint penetration
  • •Multiple screws unnecessarily
  • •Missing contralateral slip