- Clinical science
Slipped capital femoposterior and inferior displacement of the femoral head in relation to the femoral neck at the proximal femoral growth plate. It occurs most commonly in adolescent males. While the etiology is not entirely understood, multiple risk factors such as obesity and endocrine disorders have been identified. SCFE may have an acute or insidious onset, with hip pain, limping, and restricted movement of the affected hip. If the patient is unable to walk then the SCFE is considered unstable, which increases the risk of complications such as avascular necrosis. Conventional x-ray confirms the displacement. Surgical fixation of the femoral head is the only treatment.iphysis (SCFE) refers to the
- Most common hip disorder in adolescents
- Peak incidence: 10–16 years (often occurs during a growth spurt)
- Sex: ♂ > ♀
Epidemiological data refers to the US, unless otherwise specified.
- Acute, chronic (3 weeks to several months), or acute on chronic (chronic with acute exacerbations) onset
- Dull pain in the medial thigh, knee , groin, or hip pain (often left > right)
- Sudden limp
- Restricted range of motion
- Bilateral in ∼ 40% of cases
- SCFE may be stable or unstable
- Stable SCFE (∼ 90%): able to bear weight on affected hip, with or without crutches
- Unstable SCFE (∼ 10%) : inability to ambulate and bear weight on affected hip, even with crutches
Confirmatory test: x-ray
- Rules out underlying medical conditions (e.g., rickets)
- Determines degree of displacement
- Consider laboratory tests to exclude endocrinopathies in patients with an atypical age of onset or short stature.
- See “”
Snapping hip syndrome
- Definition: Snapping hip syndrome is the snapping of the iliotibial band or gluteus maximus over the greater trochanter (external), or snapping of the iliopsoas tendon over the iliopectineal eminence (internal).
- Sex: ♀ > ♂
- Peak incidence: 15–40 years
- Clinical features
- Physical therapy, rest, ice
- Injection of local anesthetic
- If complaints persist: surgical treatment
The differential diagnoses listed here are not exhaustive.
- Avoid weight bearing before stabilization
- Urgent surgical internal fixation with pinning of the femoral head
- Prophylactic fixation of the contralateral hip
- Early hip osteoarthritis
We list the most important complications. The selection is not exhaustive.